Myocardial Infarction: anticoagulation therapy prevents mural thrombi.

Clinical bottom line (level 1a)

  1. Patients with myocardial infarction are at an increased risk of embolism if they have a mural thrombus.
  2. Patients with anterior myocardial infarction who are given anticoagulants are less likely to have a mural thrombus, than those not given anticoagulants.
  3. Patients given thrombolytic therapy are less likely to have a mural thrombus than those not given thrombolytics.
  4. Patients with myocardial infarction and mural thrombi who are given anticoagulation therapy are less likely to be at risk of an embolism.
Vaitkus and Barnathan: Journal of the American College of Cardiology 1993; 22: 1004-1009
Expires March 2003

The study

Systematic review of of
  • Patients: acute anterior Q wave myocardial infarction
  • Intervention: anticoagulation compared with no anticoagulation
  • Outcome: prevention of mural thrombus


Articles found in English using MEDLINE, ? (search terms: not given ) and Manual review of references cited in the bibliographies of identified studies.

Selection criteria: As above and including then use of two-dimensional echocardiography to identify left ventricular thrombus
Appraisal criteria: not detailed in text
Articles excluded if: Studies published only as abstracts or in books or monographs not subject to peer review, studies using historical controls and studies combining anterior and inferior infarctions

11 studies enrolling a total of 856 patients were included.

The evidence

Outcome Time to outcome CER OR
(95% CI)		 NN?
(% CI)
prevention of mural thrombus formation with anticoagulants unknown /
(%)		 0.32
(0.20 to 0.52)
prevention of mural thrombus formation with thrombolytic therapy unknown /
(%)		 0.48
(0.29 to 0.79)
reduction of embolic risk of mural thrombi with anticoagulation unknown /
(%)		 0.14
(0.04 to 0.52)

prognostic factor for
emboli 		time to outcome control rate (%) unadjusted OR
(95% CI)
mural thrombus ? 5.45
(3.02 to 9.83)

Comments

  1. There remains an issue as to whether and how to screen for mural thrombi.

Citation

  1. Vaitkus PT, and Barnathan ES: Embolic potential, prevention and management of mural thrombus complicating anterior myocardial infarction: A meta-analysis. Journal of the American College of Cardiology 1993; 22: 1004-1009
Contributor: Clare Wotton and Musab Hayatli, December 1999
Reviewer: Timo Strandberg

Clinical Question.
Patient acute myocardial infarction
Intervention or Exposure anticoagulation
Comparison no anticoagulation
Outcome prevention of mural thrombus