Aiham Albaeni MD, Shuang Li PhD, Yong Shan PhD, Ravi Thakker MD, Diann E. Gaalema PhD, Ritika Saxena MPH, Yong-fang Kuo PhD, Hani Jneid MD, James Goodwin MD
{"title":"Outcomes Associated With Novel Oral Anticoagulants and Warfarin in Patients With Cardiac Thrombus Following ST-Segment Elevation Myocardial Infarction","authors":"Aiham Albaeni MD, Shuang Li PhD, Yong Shan PhD, Ravi Thakker MD, Diann E. Gaalema PhD, Ritika Saxena MPH, Yong-fang Kuo PhD, Hani Jneid MD, James Goodwin MD","doi":"10.1016/j.amjcard.2024.11.006","DOIUrl":null,"url":null,"abstract":"<div><div>The treatment of cardiac thrombus after ST-segment elevation myocardial infarction (STEMI) is anticoagulation. There are conflicting data on the effectiveness and safety of novel oral anticoagulants (NOACs) versus warfarin. Using the national Medicare data, we identified patients with an admission diagnosis of STEMI and cardiac thrombus within 6 months after STEMI. Patients were divided into 2 groups based on initial type of anticoagulation medication (NOACs vs warfarin). The 2 main outcomes were ischemic stroke/transient ischemic attack and bleeding. Follow-up was performed through the end of 2023. Kaplan–Meier curves and Cox proportional hazard models were used. Of 881 patients prescribed anticoagulation after STEMI with subsequent cardiac thrombus, 496 patients were prescribed NOACs (56.3%) and 385 patients (43.7%) were prescribed warfarin. For ischemic stroke, the median follow-up time was 177 days (95% confidence interval [CI] 148 to 193) for warfarin and 266 days (95% CI 204 to 326) for NOACs. There was a significantly lower risk of ischemic stroke or transient ischemic attack in patients with cardiac thrombus treated with NOACs than those treated with warfarin [hazard ratio 0.73 (0.57 to 0.93)]. For bleeding, the median follow-up time was 192 days (95% CI 175 to 232) for warfarin and 277 days (95% CI 212 to 332) for NOACs. There was also a lower risk of bleeding in patients treated with NOACs than those treated with warfarin (hazard ratio 0.78, CI 0.66 to 0.92). In conclusion, patients with STEMI with cardiac thrombus had a lower risk of ischemic stroke and bleeding when treated with NOACs than when treated with warfarin. Prospective randomized studies are needed to confirm these findings and further examine the comparative effectiveness of different anticoagulant strategies.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"236 ","pages":"Pages 72-78"},"PeriodicalIF":2.3000,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"American Journal of Cardiology","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S000291492400794X","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
Abstract
The treatment of cardiac thrombus after ST-segment elevation myocardial infarction (STEMI) is anticoagulation. There are conflicting data on the effectiveness and safety of novel oral anticoagulants (NOACs) versus warfarin. Using the national Medicare data, we identified patients with an admission diagnosis of STEMI and cardiac thrombus within 6 months after STEMI. Patients were divided into 2 groups based on initial type of anticoagulation medication (NOACs vs warfarin). The 2 main outcomes were ischemic stroke/transient ischemic attack and bleeding. Follow-up was performed through the end of 2023. Kaplan–Meier curves and Cox proportional hazard models were used. Of 881 patients prescribed anticoagulation after STEMI with subsequent cardiac thrombus, 496 patients were prescribed NOACs (56.3%) and 385 patients (43.7%) were prescribed warfarin. For ischemic stroke, the median follow-up time was 177 days (95% confidence interval [CI] 148 to 193) for warfarin and 266 days (95% CI 204 to 326) for NOACs. There was a significantly lower risk of ischemic stroke or transient ischemic attack in patients with cardiac thrombus treated with NOACs than those treated with warfarin [hazard ratio 0.73 (0.57 to 0.93)]. For bleeding, the median follow-up time was 192 days (95% CI 175 to 232) for warfarin and 277 days (95% CI 212 to 332) for NOACs. There was also a lower risk of bleeding in patients treated with NOACs than those treated with warfarin (hazard ratio 0.78, CI 0.66 to 0.92). In conclusion, patients with STEMI with cardiac thrombus had a lower risk of ischemic stroke and bleeding when treated with NOACs than when treated with warfarin. Prospective randomized studies are needed to confirm these findings and further examine the comparative effectiveness of different anticoagulant strategies.
期刊介绍:
Published 24 times a year, The American Journal of Cardiology® is an independent journal designed for cardiovascular disease specialists and internists with a subspecialty in cardiology throughout the world. AJC is an independent, scientific, peer-reviewed journal of original articles that focus on the practical, clinical approach to the diagnosis and treatment of cardiovascular disease. AJC has one of the fastest acceptance to publication times in Cardiology. Features report on systemic hypertension, methodology, drugs, pacing, arrhythmia, preventive cardiology, congestive heart failure, valvular heart disease, congenital heart disease, and cardiomyopathy. Also included are editorials, readers'' comments, and symposia.