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Optimal anticoagulation unclear for aSTEMI patients with impaired LVEF
11 March 2010
MedWire News: Trial findings suggest that triple antiplatelet therapy (TT) does not have clear benefits over dual therapy (DT) for patients with impaired left ventricular ejection fraction (LVEF) following anterior ST-elevation myocardial infarction (aSTEMI).
The exploratory open-labeled randomized trial found no significant difference in 3-month outcomes of patients given TT (n=10) consisting of warfarin, aspirin, and clopidogrel compared with those given aspirin and clopidogrel only (n=10).
Patients given TT were as likely as those given DT to reach the composite endpoint of death, MI, stroke, systemic embolization, left ventricular thrombus (LVT), and major bleeding, at 20% (one LVT and one major bleeding) versus 10% (one MI).
Jon-David Schwalm and co-workers (Hamilton Health Sciences and McMaster University in Ontario, Canada) note, however, that the study was unpowered to find a significant difference between the two treatment groups.
Writing in the Journal of Thrombosis and Thrombolysis, they explain the difficulties in recruiting patients to the trial. Just 52 of the 295 aSTEMI patients in their institution between 2006 and 2008 met the criteria of an LVEF below 40% and no evidence of LVT. Of these patients, 32 were unavailable, mostly due to prompt repatriation to their referring hospital.
Schwalm et al note that of the 90 aSTEMI patients with an LVEF less than 40%, just 64 (71.0%) were screened for LVT before discharge. Of these patients, 17 (26.6%) were diagnosed with probable or definite LVT, even though almost all (94.0%) had undergone early revascularization.
“STEMI patients have a high incidence of LVT despite the routine use of early revascularization and DT,” the team conclude.
