Triple Antithrombotic Therapy vs Dual Antiplatelet for Prevention of Left Ventricular Thrombus After Anterior...

PurposeTo evaluate the efficacy and safety of triple antithrombotic therapy (TT) versus dual antiplatelet therapy (DAPT) for prevention of left ventricular thrombus (LVT) following anterior myocardial infarction.MethodsWe conducted a systematic review and meta-analysis of randomized and observational studies comparing TT (DAPT plus anticoagulation) versus DAPT alone. The primary outcome was LVT formation. Secondary outcomes included all-cause mortality, stroke, systemic embolism, composite thromboembolism, bleeding, and net adverse clinical events (NACE). Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using random-effects models. The protocol was registered in PROSPERO (CRD420261343867).ResultsSeven studies (2 randomized, 5 observational), including 2,273 patients (949 TT, 1,324 DAPT), were analyzed. TT was not associated with a reduction in LVT (OR 0.56, 95% CI 0.21-1.49; p=0.25; I²=59%). There was no significant difference in all-cause mortality (OR 0.75, 95% CI 0.27-2.06; p=0.58), ischemic cerebrovascular accidents (OR 1.17, 95% CI 0.20-6.79), systemic embolism (OR 0.69, 95% CI 0.27-1.75), or composite thromboembolism (OR 0.96, 95% CI 0.42-2.19). TT was associated with increased major bleeding (OR 2.82, 95% CI 1.40-5.68; p=0.004) and any bleeding (OR 2.58, 95% CI 1.73-3.85; p<0.001). There was no significant difference in NACE (OR 1.15, 95% CI 0.58-2.29).ConclusionIn anterior myocardial infarction, available evidence did not demonstrate a statistically significant reduction in LVT or thromboembolic events with TT compared with DAPT, while bleeding risk was increased. Given moderate heterogeneity, limited randomized evidence, and potential imaging-related under-detection of LVT, these findings do not support routine prophylactic TT and favor individualized risk-benefit assessment.