Abstract 13589: Prophylactic Anticoagulation to Prevent Left Ventricular Thrombus Following Myocardial Infarction: A Systematic Review and Meta-Analysis

Introduction: Left ventricular thrombus (LVT) complicates an estimated 12% of anterior STEMI. The current standard of care for STEMI patients includes primary PCI and dual antiplatelet therapy (DAPT). Guidelines from the American Heart Association recommend consideration of prophylactic anticoagulation to prevent LVT in select high-risk patients following STEMI. These guidelines have a low certainty of evidence (level C), with most studies published prior to the current era of primary PCI and DAPT. Therefore, an updated review is needed in this area.

Methods: Electronic databases, including EMBASE, MEDLINE and CENTRAL were systematically searched from January 2012 to June 2022. We included primary studies that used PCI as the lone revascularization strategy for STEMI. Studies were included if they compared the incidence of LVT in patients receiving prophylactic anticoagulation and DAPT with those receiving DAPT alone.

Results: 7,378 studies were screened, with 4 studies eventually included in this review. One study was a randomized control trial and three were retrospective cohort studies. Pooled analysis using a fixed-effects model showed LVT was significantly less common in the triple therapy (TT) group compared to the DAPT group (OR = 0.38; 95% CI = 0.17-0.86; p = 0.02). However, using a random-effects model, there was no significant difference in LVT between the TT and DAPT group (OR = 0.42; 95% CI = 0.04-4.67; p = 0.33).

Conclusions: Based on the current state of knowledge, there is no compelling evidence to either support or oppose prophylactic anticoagulation in STEMI. An appropriately powered clinical trial is warranted due to the need for more robust data in this area.