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• W2765495587 abstract "We would like to expand on the article by Bastiany et al.,1Bastiany A. Grenier M. Matteau A. et al.Prevention of left ventricular thrombus formation and systemic embolism after anterior myocardial infarction: a systematic literature review.Can J Cardiol. 2017; 33: 1229-1236Abstract Full Text Full Text PDF PubMed Scopus (14) Google Scholar recently published in the Canadian Journal of Cardiology, reviewing the heterogeneous literature focusing on the optimal long-term antithrombotic treatment for prevention of left ventricular thrombus (LVT) after anterior ST-elevation myocardial infarction (STEMI). They should be commended for undertaking this large amount of work, highlighting the fact that the contemporary incidence of LVT in these patients is ill-defined and that the antithrombotic regimen optimizing a trade-off between ischemic protection and bleeding risks is still lingering. In fact, the largest study identified in their review included only 517 patients and was performed in the thrombolysis era. It is worth mentioning that a recent Canadian registry-based observational study published after Bastiany et al.2Shavadia J, Youngson E, Bainey K, Bakal J, Welsh R. Outcomes and prognostic impact of prophylactic oral anticoagulation in anterior st-segment elevation myocardial infarction patients with left ventricular dysfunction [e-pub ahead of print]. J Am Heart Assoc https://doi.org/10.1161/JAHA.117.006054.Google Scholar performed their literature search showed that in the current era, in 436 patients with STEMI and a left ventricular (LV) ejection fraction ≤ 40%, the use of warfarin was not associated with an improved ischemic composite outcome.2Shavadia J, Youngson E, Bainey K, Bakal J, Welsh R. Outcomes and prognostic impact of prophylactic oral anticoagulation in anterior st-segment elevation myocardial infarction patients with left ventricular dysfunction [e-pub ahead of print]. J Am Heart Assoc https://doi.org/10.1161/JAHA.117.006054.Google Scholar We put in place the largest registry, to our knowledge, aiming to elucidate the role of oral anticoagulation in preventing LVT in patients with anterior STEMI and new-onset anteroapical wall motion abnormalities, with an expected sample size of > 2000 patients: the Management of STEMI With Anterior Wall Motion Abnormalities Using Triple vs Double Antithrombotic therapy (MAGIC) study. The preliminary results of this fellow-initiated research project,3Marquis-Gravel G. Avram R. Tremblay-Gravel M. et al.Collectively operated fellow-initiated research as a novel teaching model to bolster interest and increase proficiency in academic research.Can J Cardiol. 2017; 33: 685-687Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar involving the deployment of massive logistic efforts by trainees from all the medical schools in the province of Quebec, show that the incidence of LVT is still surprisingly clinically significant in the era of primary percutaneous coronary intervention and highly potent antiplatelet therapy. Among the 526 patients included in the interim analysis, the inhospital rate of LVT was 5.1%, and the 12-month rate was 1.4%. The role of anticoagulation in this context will be assessed using multiple adjustment methods in different subgroups on completion of data collection in late 2018. In light of the review by Bastiany et al.,1Bastiany A. Grenier M. Matteau A. et al.Prevention of left ventricular thrombus formation and systemic embolism after anterior myocardial infarction: a systematic literature review.Can J Cardiol. 2017; 33: 1229-1236Abstract Full Text Full Text PDF PubMed Scopus (14) Google Scholar and given that expert guidelines provide conflicting guidance for prevention of LVT (Canadian guidelines under preparation),4O'Gara P.T. Kushner F.G. Ascheim D.D. et al.2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines.J Am Coll Cardiol. 2013; 61: e78-e140Crossref PubMed Scopus (2430) Google Scholar we agree with the authors that large-scale studies are required to improve patient care when addressing this commonly encountered clinical conundrum. Recent evidence showing an improved safety profile of various combinations of direct oral anticoagulants over warfarin in patients with percutaneous coronary intervention and atrial fibrillation could constitute the basis of a rationale for a trial focusing on patients with anterior STEMI and LV dysfunction. G.M-G. has received research funding from Bayer (significant) and Boston Scientific (significant). He has received honoraria and consulting fees from Bayer (not significant), AstraZeneca (not significant), and Boston Scientific (not significant). None of these disclosures are relevant to the content of this letter. The other authors have no conflicts of interest to disclose. Prevention of Left Ventricular Thrombus Formation and Systemic Embolism After Anterior Myocardial Infarction: A Systematic Literature ReviewCanadian Journal of CardiologyVol. 33Issue 10PreviewAnterior myocardial infarction (MI) with apical dysfunction is associated with an increased risk of left ventricular thrombus (LVT) formation and systemic embolism (SE). However, the role for prophylactic anticoagulation in current practice is a matter of debate. Full-Text PDF LVT Prophylaxis After Anterior ST-Elevation Myocardial Infarction: A Response to Marquis-Gravel et al.Canadian Journal of CardiologyVol. 34Issue 1PreviewMarquis-Gravel and colleagues point out that a recent publication on the subject of left ventricular thrombus (LVT) prophylaxis was not available at the time of our analysis. Indeed, in their article, Shavadia et al.1 reported on a mixed revascularization population with anterior ST-elevation myocardial infarction and reduced ejection fraction (< 40%) and reported no benefit to warfarin anticoagulation in terms of an ischemic composite outcome, but that it was associated with an increased risk of bleeding events. Full-Text PDF" @default.
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• W2765495587 title "The Ongoing Quest for Optimal Thrombus Prevention After ST-Elevation Myocardial Infarction in the Modern Era" @default.
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