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Anticoagulation in Ischemic Left Ventricular Aneurysm

      Abstract

      Objective

      To evaluate the role of systemic anticoagulation using warfarin in patients with post–myocardial infarction left ventricular (LV) aneurysm formation with or without definite LV thrombus formation.

      Patients and Methods

      This study included 648 patients with post–myocardial infarction LV aneurysm formation diagnosed retrospectively by 2-dimensional echocardiography from December 1, 1994, to February 29, 2012. Of these 648 patients, 106 patients received warfarin and 542 patients did not. We studied a composite of death, nonfatal myocardial infarction, cerebrovascular accident, and systemic embolization as the primary outcome and a composite of cerebrovascular accident and systemic embolization as the secondary outcome by using propensity score–adjusted multiple Cox proportional hazards regression analysis.

      Results

      In patients with LV aneurysm, LV thrombus was observed in 89 patients (13.7%) and it was associated with a higher incidence of adverse secondary events (hazard ratio [HR], 3.63; 95% CI, 1.12-11.8; P=.03) in unadjusted analysis. However, in adjusted analysis, anticoagulation did not predict either a better or a worse outcome for primary outcomes (HR, 1.05; 95% CI, 0.67-1.64; P=.84) or for secondary outcomes (HR, 1.52; 95% CI, 0.670-3.46; P=.31). The benefit of anticoagulation was also not established in patients with LV thrombus (HR, 1.38; 95% CI, 0.32-5.97; P=.66).

      Conclusion

      In patients with ischemic LV aneurysms, oral anticoagulation therapy with warfarin may not be effective enough to reduce cardiac and cerebrovascular events including systemic embolism. Further studies are needed to confirm this finding.

      Abbreviations and Acronyms:

      CVA (cerebrovascular accident), HR (hazard ratio), LV (left ventricular), LVA (left ventricular aneurysm), MI (myocardial infarction), NT-proBNP (N-terminal prohormone of brain natriuretic peptide)
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