Abstract：
Clinical practice guidelines from the American Heart Association recommend consideration of prophylactic anticoagulation to prevent left ventricular thrombus (LVT) formation in patients with anterior ST-elevation myocardial infarction. These guidelines were given a low certainty of evidence (class IIb, level C), relying primarily on case studies and expert consensus to inform practice. Our objective was to compare the safety and efficacy of prophylactic anticoagulation, in addition to dual antiplatelet therapy, in the current era of timely primary percutaneous coronary intervention. Electronic databases, including EMBASE, MEDLINE, and Cochrane Library, were systematically searched from January 2012 through June 2022. A total of 7,378 publications were screened, and 5 publications were eventually included in this review: 1 randomized control trial and 4 retrospective studies involving 1,461 patients. Data were pooled using a fixed-effects model and reported as odds ratios (ORs) with 95% confidence intervals (CIs). The primary outcome of interest was the rate of LVT formation, and the secondary outcomes were the rate of major bleeding and systemic embolism. Pooled analysis showed a significantly lower rate of LVT formation (OR 0.28, 95% CI 0.11 to 0.73, p <0.01) and significantly higher rates of bleeding (OR 2.85, 95% CI 1.13 to 7.24, p = 0.03) in the triple therapy group compared with dual antiplatelet therapy. No significant difference was observed in the rate of systemic embolism between the groups (OR 0.37, 95% CI 0.12 to 1.13, p = 0.08). In this meta-analysis, there is no conclusive evidence to either support or oppose the use of triple therapy for LVT prevention in patients with anterior ST-elevation myocardial infarction treated with primary percutaneous coronary intervention. Appropriately powered randomized controlled trials are warranted to further evaluate the benefits of LVT prevention against the risks of major bleeding in this population.
摘要：
美国心脏协会的临床实践指南建议考虑预防性抗凝以预防前部ST段抬高型心肌梗死患者的左心室血栓（LVT）形成。这些指南的证据确定性较低(IIb类，C级),主要依靠案例研究和专家共识来为实践提供信息。我们的目的是比较预防性抗凝的安全性和有效性，除了双重抗血小板治疗，在当前时代的及时直接经皮冠状动脉介入治疗。电子数据库,包括EMBASE,MEDLINE,和Cochrane图书馆,从2012年1月到2022年6月进行了系统搜索。共筛选了7,378份出版物,5篇出版物最终纳入这篇综述:1篇随机对照试验和4篇回顾性研究,涉及1,461例患者.使用固定效应模型汇总数据，并报告为比值比（ORs）和95％置信区间（CI）。感兴趣的主要结果是LVT形成率，次要结局是大出血和全身栓塞的发生率.汇总分析显示，与双重抗血小板治疗相比，三联疗法组的LVT形成率明显较低（OR0.28，95％CI0.11至0.73，p<0.01），出血率明显较高（OR2.85，95％CI1.13至7.24，p=0.03）。两组之间的全身性栓塞发生率没有显着差异（OR0.37，95％CI0.12至1.13，p=0.08）。在这个荟萃分析中，对于接受直接经皮冠状动脉介入治疗的前部ST段抬高型心肌梗死患者,没有确凿的证据支持或反对使用三联疗法预防LVT.有必要进行适当的随机对照试验，以进一步评估LVT预防对该人群大出血风险的益处。
