scholarly journals The prognostic impact of left ventricular thrombus resolution after acute coronary syndrome and risk modulation via antithrombotic treatment strategies

2021 ◽  
Author(s):  
Felix Hofer ◽  
Niema Kazem ◽  
Ronny Schweitzer ◽  
Patricia Horvat ◽  
Max‐Paul Winter ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Treatment Strategies ◽  
Left Ventricular ◽  
Left Ventricular Thrombus ◽  
Prognostic Impact ◽  
Antithrombotic Treatment ◽  
Coronary Syndrome ◽  
Ventricular Thrombus

scholarly journals The Prognostic Impact of Left Ventricular Thrombus Resolution after Acute Coronary Syndrome and Risk Modulation via Anti-Thrombotic Treatment Strategies

2021 ◽  
Author(s):  
Felix Hofer ◽  
Niema Kazem ◽  
Ronny Schweitzer ◽  
Patricia Horvat ◽  
Max-Paul Winter ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Patient Population ◽  
Treatment Strategies ◽  
Left Ventricular ◽  
Left Ventricular Thrombus ◽  
Prognostic Impact ◽  
Inverse Association ◽  
Long Term Outcome ◽  
Coronary Syndrome ◽  
Ventricular Thrombus

Abstract Background: Left ventricular thrombus (LVT) is a rare but dreaded complication during the acute phase of acute coronary syndrome (ACS). However, profound data on long-term outcome and associated anti-thrombotic treatment strategies of this highly vulnerable patient population are scarce in current literature. Methods: Patients presenting with ACS were screened for presence of LVT and subsequently included within a prospective clinical registry. All-cause mortality and the composite of MACE and thrombo-embolic events were defined as primary and secondary endpoint. Results: Within 43 patients presenting with LVT, thrombus resolution during patient follow-up was observed in 27 individuals (62.8%). Patients that reached a resolution of LVT experienced lower incidence rates of death (-23.9%; p=0.022), MACE (-37.8%; p=0.005) and thrombo-embolic events (-35.2%; p=0.008). Even after adjustment for clinical variables, thrombus resolution showed an independent inverse association with all-cause death with an hazard ratio (HR) of 0.14 (95%CI: 0.03-0.75; p=0.021) and as well as with MACE with a HR of 0.22 (95%CI: 0.07-0.68; p=0.008) and thrombo-embolic events with a HR of 0.22 (95%CI: 0.06-0.75; p=0.015). Triple antithrombotic therapy (TAT) with ticagrelor/prasugrel showed a strong and independent association with thrombus resolution with an adjusted HR of 3.25 (95%CI: 1.22-8.68; p=0.019) compared to other strategies. Conclusion: The presented data indicate a poor outcome of ACS patients experiencing LVT. In terms of a personalized risk stratification, thrombus resolution has a strong protective impact on both all-cause death and MACE with the potential to tailor treatment decisions – including an intensified anti-thrombotic treatment approach – in this patient population.

Direct Oral Anticoagulants in the Treatment of Left Ventricular Thrombus: A Retrospective, Multicenter Study and Meta-Analysis of Existing Data

2020 ◽  
pp. 107424842096764 ◽  
Author(s):  
John M. Cochran ◽  
Xiaoming Jia ◽  
Jessica Kaczmarek ◽  
Kristen A. Staggers ◽  
Mahmoud Al Rifai ◽  
...  
Keyword(s):  
Controlled Trial ◽  
Meta Analysis ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Left Ventricular ◽  
Left Ventricular Thrombus ◽  
Coronary Syndrome ◽  
Ventricular Thrombus ◽  
Existing Data

Aim: To compare the safety and efficacy of direct oral anticoagulants (DOAC) relative to vitamin K antagonists (VKA) for the treatment of left ventricular thrombus (LVT). Methods: This retrospective study enrolled patients diagnosed with LVT from 2014-2017. Patient characteristics and outcomes within 12 months of LVT diagnosis were recorded and analyzed. A meta-analysis was also performed by pooling our results with existing data in literature. Results: 14 DOAC and 59 VKA patients were included. Baseline demographic and clinical characteristics were similar except for age. Although more strokes within 12 months occurred in VKA (15%) than in DOAC (0%) patients, this was not statistically significant (p = 0.189). There were no significant differences in outcomes between patients on DOAC and VKA for acute coronary syndrome (ACS) (7%, vs 3.4%, p = .477), LVT resolution (86% vs 76%, p = .499) or bleeding (14% vs 14%, p = 1) within 12 months. The meta-analysis included 6 studies (n = 408 for DOACs; n = 1207 for VKA). There were no significant differences between DOACs versus VKAs with respect to odds for unresolved thrombus (OR 0.61, 95% CI 0.26,1.41), embolic events (OR 1.24, 95% CI 0.90,1.69), embolic events and death (OR 1.10, 95% CI 0.84,1.45) or bleeding events (OR 1.13, 95% CI 0.74,1.72). Conclusions: Our study and meta-analysis suggest similar efficacy and safety of DOACs in the treatment of LVT compared to VKA. These findings underscore the need for a randomized controlled trial.

Antithrombotic therapy for acute coronary syndrome: Past, present and future

2017 ◽  
Vol 117 (07) ◽  
pp. 1240-1248 ◽  
Author(s):  
Dirk Sibbing ◽  
Dominick J. Angiolillo ◽  
Kurt Huber
Keyword(s):  
Acute Coronary Syndrome ◽  
Thrombus Formation ◽  
Blood Platelets ◽  
Treatment Strategies ◽  
Coagulation Cascade ◽  
Current Guideline ◽  
Antithrombotic Treatment ◽  
Coronary Syndrome ◽  
Research Activities ◽  
Number Of Patients

SummaryPlaque erosions and ruptures are the histopathological hallmarks of arterial thrombus formation in the coronary arteries. The clinical condition associated with this process is usually referred to as acute coronary syndrome (ACS). Importantly, both blood platelets and the coagulation cascade are key players for initiation, amplification and perpetuation of ACS. There has been great progress in ACS treatment in recent decades, both at the technical level of (percutaneous) revascularisation and at the level of antithrombotic treatment. Numerous trials have led to significant advancements in the development of effective anticoagulant and antiplatelet drugs. The large number of randomised controlled clinical trials (RCTs) and the huge number of patients enrolled in these RCTs, with mega trials including >10,000 patients, is unique in the history of medical research and also reflects the exceptional efforts associated with these huge research activities. The crucial issue, however, with respect to optimising treatment, relates to finding the delicate balance between the reduction of thrombotic events by effective drug treatment and the induction of bleeding that is linked to the use of potent or multiple antithrombotic agents. Interestingly, there is a gap in modern days between current guideline recommendations favouring potent platelet inhibition in ACS and the utilization of the respective drugs in clinical practice. In this review, we will summarise and discuss the past, present and future antithrombotic treatment for ACS patients with a focus on the development of optimised antiplatelet treatment strategies and their utilisation in the real world.

CONTEMPORARY ETIOLOGIES, TREATMENT STRATEGIES, AND OUTCOMES OF LEFT VENTRICULAR THROMBUS

2019 ◽  
Vol 73 (9) ◽  
pp. 716
Author(s):  
Cian McCarthy ◽  
Sean Murphy ◽  
Ramkumar V. Venkateswaran ◽  
Avinainder Singh ◽  
Leslie L. Chang ◽  
...  
Keyword(s):  
Treatment Strategies ◽  
Left Ventricular ◽  
Left Ventricular Thrombus ◽  
Ventricular Thrombus

Prognostic impact of left ventricular thrombus resolution after myocardial infarction on cardiovascular events and mortality

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
F Hofer ◽  
P Sulzgruber ◽  
N Kazem ◽  
P Horvath ◽  
R Schweitzer ◽  
...  
Keyword(s):  
Cardiovascular Events ◽  
Left Ventricular ◽  
Prognostic Impact ◽  
Coronary Syndrome ◽  
Ventricular Thrombus ◽  
All Cause Mortality ◽  
Vulnerable Patient ◽  
Vulnerable Patient Population

Abstract Background Left ventricular thrombus (LVT) is a rare but dreaded complication during the acute phase of acute coronary syndrome (ACS). Incidence rates differ among the observational studies from 1.6% up to 39.0% indicating that many LVT cases might remain undetected. While the prognosis of patients presenting with LVT after ACS has been controversially discussed, it seems intuitive that individuals in whom the thrombus remains have an increased risk for cardiovascular events and mortality. However, profound data on long-term outcome of this highly vulnerable patient population are not available in current literature. Therefore, we aimed to investigate the impact of LVT resolution on patient's outcome from a long-term perspective. Methods We collected data of patients with acute coronary syndrome (n=2011) who underwent treatment between 01/2016 and 09/2019. Patients with a confirmed LVT were included in this analysis. Repeated echocardiographic data, treatment management and clinical outcomes were collected during follow-up. All-cause mortality and major adverse cardiac events (MACE), defined as nonfatal stroke, nonfatal myocardial infarction, nonfatal systemic embolism and cardiovascular death were chosen as primary and secondary endpoint. Results Among 2011 patients with ACS, 52 patients (2.6%) developed left ventricular thrombosis (median age: 63±13). 80.5% of LVT patients presented with STEMI. Out of those 52 patients with LVT, 6 died before hospital discharge and 3 did not receive follow-up imaging. In total 13 patients (24%) died. Mean time to thrombus resolution was 23±31 weeks. Mean follow-up time was 98±69.6 weeks. 43 patients received oral anticoagulation including 7 patients (16%) receiving novel oral anticoagulants (NOACs) and 32 patients (84%) Vitamin K antagonists (VKA). All patients developed LVT after anterior wall infarction. From the time of hospital admission all patients were followed prospectively until the primary endpoint was reached. Thrombus resolution was observed in 27 patients (62.8). As expected, thrombus resolution was associated with a significant lower risk of MACE with a crude hazard ratio (HR) of 3.89 (95% CI 1.30–11.65; P=0.015) and mortality with a crude HR of 5.59 (95% CI 1.07–29.07; P=0.041). Notably, the prognostic impact remained stable after comprehensive adjustment for potential confounders with an adjusted HR of 5.38 for MACE and an adjusted HR of 6.10 for overall mortality. Conclusion Present data clearly highlighted the prognostic potential of thrombus resolution on both MACE and all-cause mortality in individuals presenting with LVT after ACS. Therefore, thrombus resolution might be considered for risk stratification and an intensified anti-thrombotic approach should be taken into account in this highly vulnerable patient population. Survival curves Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Medical University of Vienna

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