Anticoagulation after anterior myocardial infarction and the risk of stroke.

<h4>Background</h4>Survivors of anterior MI are at increased risk for stroke with predilection to form ventricular thrombus. Commonly patients are discharged on dual antiplatelet therapy. Given the frequency of early coronary reperfusion and risk of bleeding, it remains uncertain whether...

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Autores principales:	Jacob A Udell, Julie T Wang, David J Gladstone, Jack V Tu
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2010
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/57d3a37c7e9f49c0af0e181b17614441
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spelling	oai:doaj.org-article:57d3a37c7e9f49c0af0e181b176144412021-11-18T06:36:05ZAnticoagulation after anterior myocardial infarction and the risk of stroke.1932-620310.1371/journal.pone.0012150https://doaj.org/article/57d3a37c7e9f49c0af0e181b176144412010-08-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/20730096/pdf/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Background</h4>Survivors of anterior MI are at increased risk for stroke with predilection to form ventricular thrombus. Commonly patients are discharged on dual antiplatelet therapy. Given the frequency of early coronary reperfusion and risk of bleeding, it remains uncertain whether anticoagulation offers additional utility. We examined the effectiveness of anticoagulation therapy for the prevention of stroke after anterior MI.<h4>Methods and findings</h4>We performed a population-based cohort analysis of 10,383 patients who survived hospitalization for an acute MI in Ontario, Canada from April 1, 1999 to March 31, 2001. The primary outcome was four-year ischemic stroke rates compared between anterior and non-anterior MI patients. Risk factors for stroke were assessed by multivariate Cox proportional-hazards analysis. Warfarin use was determined at discharge and followed for 90 days among a subset of patients aged 66 and older (n = 1483). Among the 10,383 patients studied, 2,942 patients survived hospitalization for an anterior MI and 20% were discharged on anticoagulation therapy. Within 4 years, 169 patients (5.7%) were admitted with an ischemic stroke, half of which occurred within 1-year post-MI. There was no significant difference in stroke rate between anterior and non-anterior MI patients. The use of warfarin up to 90 days was not associated with stroke protection after anterior MI (hazard ratio [HR], 0.68; 95% confidence interval [CI], 0.37-1.26). The use of angiotensin-converting-enzyme inhibitors (HR, 0.65; 95% CI, 0.44-0.95) and beta-blockers (HR, 0.60; 95% CI, 0.41-0.87) were associated with a significant decrease in stroke risk. There was no significant difference in bleeding-related hospitalizations in patients who used warfarin for up to 90 days post-MI.<h4>Conclusion</h4>Many practitioners still consider a large anterior-wall MI as high risk for potential LV thrombus formation and stroke. Among a cohort of elderly patients who survived an anterior MI there was no benefit from the use of warfarin up to 90 days post-MI to prevent ischemic stroke. Our data suggests that routine anticoagulation of patients with anterior-wall MI may not be indicated. Prospective randomized trials are needed to determine the optimal antithrombin strategy for preventing this common and serious adverse outcome.Jacob A UdellJulie T WangDavid J GladstoneJack V TuPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 5, Iss 8, p e12150 (2010)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Jacob A Udell Julie T Wang David J Gladstone Jack V Tu Anticoagulation after anterior myocardial infarction and the risk of stroke.
description	<h4>Background</h4>Survivors of anterior MI are at increased risk for stroke with predilection to form ventricular thrombus. Commonly patients are discharged on dual antiplatelet therapy. Given the frequency of early coronary reperfusion and risk of bleeding, it remains uncertain whether anticoagulation offers additional utility. We examined the effectiveness of anticoagulation therapy for the prevention of stroke after anterior MI.<h4>Methods and findings</h4>We performed a population-based cohort analysis of 10,383 patients who survived hospitalization for an acute MI in Ontario, Canada from April 1, 1999 to March 31, 2001. The primary outcome was four-year ischemic stroke rates compared between anterior and non-anterior MI patients. Risk factors for stroke were assessed by multivariate Cox proportional-hazards analysis. Warfarin use was determined at discharge and followed for 90 days among a subset of patients aged 66 and older (n = 1483). Among the 10,383 patients studied, 2,942 patients survived hospitalization for an anterior MI and 20% were discharged on anticoagulation therapy. Within 4 years, 169 patients (5.7%) were admitted with an ischemic stroke, half of which occurred within 1-year post-MI. There was no significant difference in stroke rate between anterior and non-anterior MI patients. The use of warfarin up to 90 days was not associated with stroke protection after anterior MI (hazard ratio [HR], 0.68; 95% confidence interval [CI], 0.37-1.26). The use of angiotensin-converting-enzyme inhibitors (HR, 0.65; 95% CI, 0.44-0.95) and beta-blockers (HR, 0.60; 95% CI, 0.41-0.87) were associated with a significant decrease in stroke risk. There was no significant difference in bleeding-related hospitalizations in patients who used warfarin for up to 90 days post-MI.<h4>Conclusion</h4>Many practitioners still consider a large anterior-wall MI as high risk for potential LV thrombus formation and stroke. Among a cohort of elderly patients who survived an anterior MI there was no benefit from the use of warfarin up to 90 days post-MI to prevent ischemic stroke. Our data suggests that routine anticoagulation of patients with anterior-wall MI may not be indicated. Prospective randomized trials are needed to determine the optimal antithrombin strategy for preventing this common and serious adverse outcome.
format	article
author	Jacob A Udell Julie T Wang David J Gladstone Jack V Tu
author_facet	Jacob A Udell Julie T Wang David J Gladstone Jack V Tu
author_sort	Jacob A Udell
title	Anticoagulation after anterior myocardial infarction and the risk of stroke.
title_short	Anticoagulation after anterior myocardial infarction and the risk of stroke.
title_full	Anticoagulation after anterior myocardial infarction and the risk of stroke.
title_fullStr	Anticoagulation after anterior myocardial infarction and the risk of stroke.
title_full_unstemmed	Anticoagulation after anterior myocardial infarction and the risk of stroke.
title_sort	anticoagulation after anterior myocardial infarction and the risk of stroke.
publisher	Public Library of Science (PLoS)
publishDate	2010
url	https://doaj.org/article/57d3a37c7e9f49c0af0e181b17614441
work_keys_str_mv	AT jacobaudell anticoagulationafteranteriormyocardialinfarctionandtheriskofstroke AT julietwang anticoagulationafteranteriormyocardialinfarctionandtheriskofstroke AT davidjgladstone anticoagulationafteranteriormyocardialinfarctionandtheriskofstroke AT jackvtu anticoagulationafteranteriormyocardialinfarctionandtheriskofstroke
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Anticoagulation after anterior myocardial infarction and the risk of stroke.

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