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Anticoagulation in ischemic left ventricular aneurysm

Ga Yeon Lee1, Young Bin Song1, Joo-Yong Hahn1

  • 1Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Mayo Clinic Proceedings
|March 11, 2015
PubMed

Insights

Warfarin anticoagulation did not significantly reduce adverse events in patients with post-myocardial infarction left ventricular aneurysms. This includes patients with or without left ventricular thrombus, suggesting limited benefit for this therapy.

Area of Science:

  • Cardiology
  • Cardiovascular Medicine
  • Clinical Research

Background:

  • Left ventricular (LV) aneurysm formation is a complication of myocardial infarction.
  • LV thrombus formation in aneurysms increases the risk of embolic events.
  • The efficacy of anticoagulation in this specific patient population requires clarification.

Purpose of the Study:

  • To evaluate the role of systemic anticoagulation with warfarin in patients with post-myocardial infarction LV aneurysm.
  • To assess outcomes in patients with LV aneurysm with or without LV thrombus.

Main Methods:

  • Retrospective analysis of 648 patients with post-myocardial infarction LV aneurysm.
  • Comparison of outcomes between 106 patients on warfarin and 542 patients not on warfarin.
  • Propensity score-adjusted Cox regression analysis for primary (death, MI, stroke, embolism) and secondary (stroke, embolism) outcomes.

Main Results:

  • LV thrombus was associated with higher adverse events in unadjusted analysis (HR 3.63).
  • Adjusted analysis showed no significant benefit or harm from warfarin for primary (HR 1.05) or secondary outcomes (HR 1.52).
  • Anticoagulation benefit was not established in patients with LV thrombus (HR 1.38).

Conclusions:

  • Oral anticoagulation with warfarin may not be sufficiently effective in reducing cardiac and cerebrovascular events in patients with ischemic LV aneurysms.
  • The findings suggest limited clinical benefit of warfarin for preventing systemic embolism in this cohort.
  • Further research is necessary to confirm these results and explore alternative therapeutic strategies.
Abstract

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