scholarly journals Rivaroxaban as an Antithrombotic Agent in a Patient With ST-Segment Elevation Myocardial Infarction and Left Ventricular Thrombus

2017 ◽  
Vol 5 (1) ◽  
pp. 232470961769799 ◽  
Author(s):  
Rajeev Seecheran ◽  
Valmiki Seecheran ◽  
Sangeeta Persad ◽  
Naveen Anand Seecheran
Keyword(s):  
Myocardial Infarction ◽  
Bleeding Risk ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
Bleeding Complications ◽  
Factor X ◽  
Anterior Myocardial Infarction ◽  
Antithrombotic Agent ◽  
St Segment Elevation ◽  
St Segment

The incidence of left ventricular (LV) thrombi in the setting of an anterior myocardial infarction has declined significantly since the advent of primary percutaneous coronary intervention coupled with contemporary antithrombotic strategies in ST-segment elevation myocardial infarctions (STE-ACS). Despite oral anticoagulation with the currently accepted, standard-of-care vitamin K antagonist, warfarin, major bleeding complications still arise. Rivaroxaban is a novel, direct oral factor X anticoagulant that has several advantageous properties, which can attenuate bleeding risk. We present a case in which a patient successfully underwent a 3-month course of rivaroxaban in addition to his dual antiplatelet regimen of aspirin and ticagrelor for his STE-ACS and LV thrombus with resultant complete dissolution.

scholarly journals The Association between the PRECISE-DAPT Score and New-Onset Atrial Fibrillation in Patients with ST-Elevation Myocardial Infarction

2021 ◽  
Author(s):  
Hilal Erken Pamukcu ◽  
Veysel Ozan Tanık ◽  
Barış Şimşek ◽  
İbrahim Hakan Güllü
Keyword(s):  
Myocardial Infarction ◽  
Atrial Fibrillation ◽  
Confidence Interval ◽  
Multivariate Logistic Regression Analysis ◽  
Bleeding Risk ◽  
Coronary Intervention ◽  
Bleeding Complications ◽  
St Segment Elevation ◽  
St Segment ◽  
New Onset

Background: Atrial fibrillation (AF) is associated with increased morbidity in myocardial infarction (MI), especially thromboembolic risk increases. The PRECISE-DAPT (The PREdicting bleeding Complications In patients undergoing Stent implantation and subsEquent Dual Anti-Platelet Therapy) score was created to predict the bleeding risk of dual antiplatelet therapy. The purpose of this study was to evaluate the association between new-onset AF and the PRECISE-DAPT score in ST-segment-elevation myocardial infarction (STEMI). Methods: This retrospective study enrolled patients who developed STEMI within 12 hours of the onset of symptoms and underwent primary percutaneous coronary intervention. The study population was divided into 2 groups of PRECISE-DAPT scores of 25 or greater and PRECISE-DAPT scores of below 25 and their baseline characteristics, as well as laboratory and echocardiography results, were compared. In-hospital new AF and related events were compared between the 2 PRECISE-DAPT score groups. Results: From February 2015 to December 2017, this study enrolled 2234 patients with STEMI at a mean age of 54.4 years. The new-onset AF incidence rate was higher in the higher PRECISE-DAPT group than in the lower PRECISE-DAPT group (62 [28.7 %] vs 58 [2.9%]; P<0.001). According to the multivariate logistic regression analysis, the factors associated with new-onset AF were the left atrial diameter (OR=1.98, 95% confidence interval=1.34–2.93; P=0.001) and the PRECISE-DAPT score (OR=1.04, 95% confidence interval=1.10–1.18; P<0.001). Conclusion: The PRECISE-DAPT score was associated with the development of new-onset AF in our patients with STEMI. Further follow-up of these patients will provide clearer information.  

No-reflow phenomenon in ST-segment elevation myocardial infarction: still the Achilles’ heel of the interventionalist

2020 ◽  
Author(s):  
Jonathan L Ciofani ◽  
Usaid K Allahwala ◽  
Roberto Scarsini ◽  
Avedis Ekmejian ◽  
Adrian P Banning ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
No Reflow ◽  
St Segment ◽  
Percutaneous Coronary ◽  
No Reflow Phenomenon ◽  
Management Algorithms

Improvements in systems, technology and pharmacotherapy have significantly changed the prognosis over recent decades in patients presenting with ST-segment elevation myocardial infarction. These clinical achievements have, however, begun to plateau and it is becoming increasingly necessary to consider novel strategies to further improve outcomes. Approximately a third of patients treated by primary percutaneous coronary intervention for ST-segment elevation myocardial infarction will suffer from coronary no-reflow (NR), a condition characterized by poor myocardial perfusion despite patent epicardial arteries. The presence of NR impacts significantly on clinical outcomes including left ventricular dysfunction, heart failure and death, yet conventional management algorithms neither assess the risk of NR nor treat NR. This review will provide a contemporary overview on the pathogenesis, diagnosis and treatment of NR.

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