PMID- 28501493
OWN - NLM
STAT- MEDLINE
DCOM- 20180806
LR  - 20220321
IS  - 1878-0938 (Electronic)
IS  - 1878-0938 (Linking)
VI  - 18
IP  - 8
DP  - 2017 Dec
TI  - Prophylactic warfarin post anterior ST-elevation myocardial infarction: A 
      systematic review and meta-analysis.
PG  - 559-564
LID - S1553-8389(17)30165-3 [pii]
LID - 10.1016/j.carrev.2017.05.002 [doi]
AB  - OBJECTIVES: To determine the role of warfarin (WF) prophylaxis in the prevention 
      of left ventricular thrombus (LVT) formation and subsequent embolic complications 
      following an anterior ST elevation myocardial infarction (STEMI) complicated by 
      reduced left ventricular ejection fraction (LVEF) and wall motion abnormalities. 
      BACKGROUND: The role of oral anticoagulation prophylaxis, in addition to dual 
      antiplatelet therapy (DAPT), in the current era of percutaneous coronary 
      intervention has not been well studied, despite being a class IIb recommendation 
      in the AHA/ACC STEMI guidelines. METHODS: The Cochrane search strategy was used 
      to search PubMed, Embase and the Cochrane library for relevant results. Four 
      studies, two retrospective, one prospective registry, and a randomized 
      feasibility control trial met criteria for inclusion. Data was pooled using a 
      random effects model and reported as odds ratios (OR) with their 95% confidence 
      intervals (CI). Primary outcomes of interest were rate of stroke, major bleeding 
      and mortality. RESULTS: Pooled analysis included 526 patients in the No WF group 
      and 347 patients in the WF group. No statistical difference in rate of stroke 
      (OR: 2.72 [95% CI: 0.47-15.88; p=0.21]) or mortality (OR: 1.50 [95% CI 0.29-7.71; 
      p=0.63]) was observed. Major bleeding was significantly higher in the WF group 
      (OR: 2.56 [95% CI: 1.34-4.89; p=0.004]). CONCLUSIONS: The routine use of DAPT and 
      WF for prophylaxis against LVT formation following an anterior STEMI with 
      associated decrease in LVEF and wall motion abnormalities, appears to result in 
      no mortality benefit or reduction in stroke rates, but may increase the frequency 
      of major bleeding.
CI  - Copyright (c) 2017 Elsevier Inc. All rights reserved.
FAU - Moulson, Nathaniel
AU  - Moulson N
AD  - Kingston General Hospital, Division of Cardiology, Kingston, Ontario, Canada.
FAU - LaHaye, Stephen A
AU  - LaHaye SA
AD  - Kingston General Hospital, Division of Cardiology, Kingston, Ontario, Canada.
FAU - Bertrand, Olivier F
AU  - Bertrand OF
AD  - Institut Universitaire de Cardiologie et de Pneumologie de Quebec, Division of 
      Cardiology, Quebec City, Quebec, Canada.
FAU - MacHaalany, Jimmy
AU  - MacHaalany J
AD  - Kingston General Hospital, Division of Cardiology, Kingston, Ontario, Canada. 
      Electronic address: jmach@magma.ca.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Review
PT  - Systematic Review
DEP - 20170509
PL  - United States
TA  - Cardiovasc Revasc Med
JT  - Cardiovascular revascularization medicine : including molecular interventions
JID - 101238551
RN  - 0 (Anticoagulants)
RN  - 0 (Platelet Aggregation Inhibitors)
RN  - 5Q7ZVV76EI (Warfarin)
SB  - IM
CIN - Cardiovasc Revasc Med. 2017 Dec;18(8):557-558. PMID: 29246274
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Anterior Wall Myocardial 
      Infarction/complications/mortality/physiopathology/*therapy
MH  - Anticoagulants/*administration & dosage/adverse effects
MH  - Chi-Square Distribution
MH  - Embolism/diagnosis/etiology/mortality/*prevention & control
MH  - Female
MH  - Hemorrhage/chemically induced
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Myocardial Contraction
MH  - Odds Ratio
MH  - *Percutaneous Coronary Intervention/adverse effects/mortality
MH  - Platelet Aggregation Inhibitors/administration & dosage
MH  - Risk Factors
MH  - ST Elevation Myocardial 
      Infarction/complications/mortality/physiopathology/*therapy
MH  - Stroke/etiology/prevention & control
MH  - Stroke Volume
MH  - Thrombosis/diagnosis/etiology/mortality/*prevention & control
MH  - Treatment Outcome
MH  - Ventricular Function, Left
MH  - Warfarin/*administration & dosage/adverse effects
MH  - Young Adult
OTO - NOTNLM
OT  - LV thrombus
OT  - ST elevation myocardial infarction
OT  - Triple therapy
OT  - Warfarin
EDAT- 2017/05/16 06:00
MHDA- 2018/08/07 06:00
CRDT- 2017/05/15 06:00
PHST- 2017/03/31 00:00 [received]
PHST- 2017/05/01 00:00 [revised]
PHST- 2017/05/03 00:00 [accepted]
PHST- 2017/05/16 06:00 [pubmed]
PHST- 2018/08/07 06:00 [medline]
PHST- 2017/05/15 06:00 [entrez]
AID - S1553-8389(17)30165-3 [pii]
AID - 10.1016/j.carrev.2017.05.002 [doi]
PST - ppublish
SO  - Cardiovasc Revasc Med. 2017 Dec;18(8):559-564. doi: 10.1016/j.carrev.2017.05.002. 
      Epub 2017 May 9.