scholarly journals Rate and impact of venous thromboembolism in patients with ST-segment elevation myocardial infarction: Analysis of the Nationwide Inpatient Sample database 2003–2013

2019 ◽  
Vol 24 (4) ◽  
pp. 341-348
Author(s):  
Ahmed Al-Ogaili ◽  
Ali Ayoub ◽  
Luis Diaz Quintero ◽  
Christian Torres ◽  
Harry E Fuentes ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Venous Thromboembolism ◽  
Nationwide Inpatient Sample ◽  
Bleeding Complications ◽  
Aggressive Approach ◽  
St Segment Elevation ◽  
Vte Prophylaxis ◽  
Segment Elevation Myocardial Infarction ◽  
Nationwide Inpatient Sample Database ◽  
St Segment

Venous thromboembolism (VTE) and coronary artery disease are major health issues that cause substantial morbidity and mortality. New data have emerged suggesting that these two conditions could have a close relationship. Thus, we sought to determine the trends in annual rate of VTE occurrence in patients with ST-segment elevation myocardial infarction (STEMI) and measure its impact on in-hospital mortality, bleeding complications, and cost and length of hospitalization. We queried the 2003–2013 Nationwide Inpatient Sample databases to identify adults with primary diagnosis of STEMI. VTE events were then allocated. Inpatient outcomes of patients with VTE were compared to those without VTE. Out of 2,495,757 hospitalizations for STEMI, VTE was diagnosed in 25,149 (1%) hospitalizations. Patients who experienced VTE were older (mean age: 67.5 vs 64.8, p < 0.01) and had a higher proportion of black patients (10.1% vs 7.7%, p < 0.001) and females (40.1% vs 35%, p < 0.001) compared to patients without VTE. There was an increasing trend in the rate of VTE during the study period (2003: 0.8% vs 2013: 1.0%, p < 0.001). Patients with VTE had a prolonged hospitalization (median: 9 vs 3 days, p < 0.001), increased cost, higher risk of gastrointestinal bleeding (OR: 2.13, p < 0.001), intracranial hemorrhage (OR: 2.14, p < 0.001), blood transfusions (OR: 1.94, p < 0.001), and mortality (OR: 1.39, p < 0.001). The rate of VTE occurrence in patients with STEMI in our study was 10 per 1000 admissions. VTE was associated with more bleeding complications, longer hospital stays, higher costs, and mortality. These findings suggest that a more aggressive approach for VTE prophylaxis may be warranted in this population.

scholarly journals Prognostic impact of body mass index on in-hospital bleeding complications after ST-segment elevation myocardial infarction

2020 ◽  
Vol 12 (1) ◽  
pp. 44-54 ◽  
Author(s):  
Delphine Ingremeau ◽  
Sylvain Grall ◽  
Florine Valliet ◽  
Laurent Desprets ◽  
Fabrice Prunier ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Body Mass Index ◽  
Body Mass ◽  
Bleeding Complications ◽  
Prognostic Impact ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment

Advances in antithrombotic therapy as adjunct to reperfusion therapies for ST-segment elevation myocardial infarction

2008 ◽  
Vol 100 (08) ◽  
pp. 184-195 ◽  
Author(s):  
Paolo Marino ◽  
Giuseppe De Luca
Keyword(s):  
Myocardial Infarction ◽  
Antithrombotic Therapy ◽  
Anticoagulation Therapy ◽  
Primary Angioplasty ◽  
Thrombin Inhibitors ◽  
Bleeding Complications ◽  
Direct Thrombin Inhibitors ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment

SummaryThe treatment of ST-segment elevation myocardial infarction (STEMI) has improved over the past decades, mainly due to reperfusion therapies. The aim of this article is to provide an updated review of adjunctive antithrombotic therapy to reperfusion strategies for STEMI. As compared to unfractionated heparin (UFH), among patients treated with thrombolysis, low-molecular- weight heparins (LMWHs),mainly enoxaparin, fonda-parinux and clopidogrel have been shown to improve outcome in terms of death and reinfarction, whereas GP IIb-IIIa inhibitors, mainly abciximab, and direct thrombin inhibitors have reduced reinfarction, but not mortality. Among patients undergoing primary angioplasty, early UFH should still be regarded as the gold standard in anticoagulation therapy. In addition to ASA, early GP IIb-IIIa inhibitors, especially abciximab, should be considered since it has been shown to provide further benefits in terms of preprocedural recanalization. Despite the positive results observed in the HORIZONS trial, additional studies are needed to investigate the role of bivalirudin as compared to abciximab administration. In our opinion, bivalirudin may be considered instead of GP IIb-IIIa inhibitors among STEMI patients at high risk for bleeding complications. Due to the very low mortality currently achieved by primary angioplasty, a further reduction in short- or medium-term mortality would be quite improbable to be observed. Thus, additional endpoints, such as infarct size and myocardial perfusion, may be considered in future randomized trials among patients undergoing mechanical revascularization for STEMI.

scholarly journals Safety and Efficacy of Adjunctive Catheter-Directed Thrombolysis During Primary PCI for ST-segment Elevation Myocardial Infarction With High Thrombus Burden

2021 ◽  
Author(s):  
Satsuki Noma ◽  
Hideki Miyachi ◽  
Isamu Fukuizumi ◽  
Junya Matsuda ◽  
Hideto Sangen ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Flow ◽  
Bleeding Complications ◽  
Primary Pci ◽  
Aspiration Thrombectomy ◽  
Safety And Efficacy ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
Catheter Directed Thrombolysis ◽  
St Segment

Background: High coronary thrombus burden has been associated with unfavorable outcomes in patients with ST-segment elevation myocardial infarction (STEMI), the optimal management of which has not yet to be established. Methods: We evaluated the safety and efficacy of adjunctive catheter-directed thrombolysis (CDT) during primary percutaneous coronary intervention (PCI) in patients with STEMI and high thrombus burden. Results: Among the 1,849 consecutive patients with STEMI, 263 had high thrombus burden. Moreover, 41 patients received intracoronary infusion of tissue plasminogen activator during primary PCI (CDT group), whereas 222 did not receive (non-CDT group). No significant differences in bleeding complications and in-hospital and long-term mortalities were observed (9.8% vs. 7.2%, p=0.53; 7.3% vs. 2.3%, p=0.11; and 12.6% vs. 17.5%, p=0.84, CDT vs. non-CDT). In patients who underwent antecedent aspiration thrombectomy during PCI (75.6%; CDT group and 87.4%; non-CDT group), thrombolysis in myocardial infarction grade 2 or 3 flow rate after thrombectomy was significantly lower in the CDT group than in the non-CDT group (32.2% vs. 61.0%, p&amp;lt;0.01). However, the final rates improved considerably without significant difference (90.3% vs. 97.4%, p=0.14). Conclusions: For STEMI patients with high thrombus burden, adjunctive CDT is safe and effective for improving coronary flow. CDT resulted in favorable coronary flow even after unsatisfactory aspiration thrombectomy.

scholarly journals Adjunctive Catheter-Directed Thrombolysis during Primary PCI for ST-Segment Elevation Myocardial Infarction with High Thrombus Burden

2022 ◽  
Vol 11 (1) ◽  
pp. 262
Author(s):  
Satsuki Noma ◽  
Hideki Miyachi ◽  
Isamu Fukuizumi ◽  
Junya Matsuda ◽  
Hideto Sangen ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Intervention ◽  
Bleeding Complications ◽  
Aspiration Thrombectomy ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
Catheter Directed Thrombolysis ◽  
St Segment ◽  
Percutaneous Coronary ◽  
Significant Difference

Background: High coronary thrombus burden has been associated with unfavorable outcomes in patients with ST-segment elevation myocardial infarction (STEMI), the optimal management of which has not yet been established. Methods: We assessed the adjunctive catheter-directed thrombolysis (CDT) during primary percutaneous coronary intervention (PCI) in patients with STEMI and high thrombus burden. CDT was defined as intracoronary infusion of tissue plasminogen activator (t-PA; monteplase). Results: Among the 1849 consecutive patients with STEMI, 263 had high thrombus burden. Moreover, 41 patients received t-PA (CDT group), whereas 222 did not receive it (non-CDT group). No significant differences in bleeding complications and in-hospital and long-term mortalities were observed (9.8% vs. 7.2%, p = 0.53; 7.3% vs. 2.3%, p = 0.11; and 12.6% vs. 17.5%, p = 0.84, CDT vs. non-CDT). In patients who underwent antecedent aspiration thrombectomy during PCI (75.6% CDT group and 87.4% non-CDT group), thrombolysis in myocardial infarction grade 2 or 3 flow rate after thrombectomy was significantly lower in the CDT group than in the non-CDT group (32.2% vs. 61.0%, p < 0.01). However, the final rates improved without significant difference (90.3% vs. 97.4%, p = 0.14). Conclusions: Adjunctive CDT appears to be tolerated and feasible for high thrombus burden. Particularly, it may be an option in cases with failed aspiration thrombectomy.

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