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A multi-center study will be done to explore the optimal regimen of antithrombotic therapy for acute myocardial infarction with left ventricular mural thrombus. The investigators will evaluate the different combinations of antiplatelet drugs and anticoagulants for at least one month, such as aspirin 100mg qd+clopidogrel 75mg qd+warfarin (INR1.8-2.2), aspirin 100mg qd+clopidogrel 75mg qd+dabigatran 110mg bid, aspirin 100mg qd+ticagrelor 60mg bid+warfarin (INR1.8-2.2), and aspirin 100mg qd+ticagrelor 60mg bid+dabigatran 110mg bid. Transthoracic two-dimensional echocardiography will be done at the 1-month, 3-month and 6-month follow-ups to evaluate the left ventricular mural thrombus and determinate whether the antithrombotic therapy regimen could be regulated to double antiplatelet or anticoagulant+clopidogrel 75mg qd/ticagrelor 60mg bid. Then the investigators will complete the 12-month follow-up to evaluate the efficacy and safety of the optimal antithrombotic therapy regimen for acute myocardial infarction with left ventricular mural thrombus.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| aspirin100mg qd+clopidogrel75mg qd+warfarin (INR1.8-2.2) | Experimental |
| |
| aspirin100mg qd+clopidogrel75mg qd+dabigatran110mg bid | Experimental |
| |
| aspirin100mg qd+ticagrelor60mg bid+warfarin(INR1.8-2.2) | Experimental |
| |
| aspirin100mg qd+ticagrelor60mg bid+dabigatran110mg bid | Experimental |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Combination of antiplatelet drugs and anticoagulants for at least one month | Drug | Combination of antiplatelet drugs and anticoagulants for at least one month, such as aspirin100mg qd+clopidogrel75mg qd+warfarin (INR1.8-2.2), aspirin100mg qd+clopidogrel75mg qd+dabigatran110mg bid, aspirin100mg qd+ticagrelor60mg bid+warfarin (INR1.8-2.2), and aspirin100mg qd+ticagrelor60mg bid+dabigatran110mg bid. Transthoracic two-dimensional echocardiography will be done at the 1-month, 3-month and 6-month follow-ups to evaluate the left ventricular mural thrombus and determinate whether the antithrombotic therapy regimen could be regulated to double antiplatelet or anticoagulant+clopidogrel75mg qd/ticagrelor60mg bid. |
| Measure | Description | Time Frame |
|---|---|---|
| Left ventricular mural thrombus-1 | Number of Participants Without left ventricular mural thrombus as Assessed by echocardiograph at 1-month. | 1-month |
| Left ventricular mural thrombus-3 | Number of Participants Without left ventricular mural thrombus as Assessed by echocardiograph at 3-month. | 3-month |
| Left ventricular mural thrombus-6 | Number of Participants Without left ventricular mural thrombus as Assessed by echocardiograph at 6-month. | 6-month |
| Measure | Description | Time Frame |
|---|---|---|
| Death | 12 months | |
| Recurrent myocardial infarction | 12 months | |
| Stroke or other systemic circulation embolism |
| Measure | Description | Time Frame |
|---|---|---|
| Major bleeding | Bleeding Academic Research Consortium (BARC) bleedings ≥ 2 | 12 months |
| Minor bleeding | BARC bleedings < 2 | 12 months |
Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Liansheng Wang, Doctor | Contact | 86 25 68303125 | drlswang@njmu.edu.cn | |
| Haoyu Meng, Doctor | Contact | 86 25 68303126 | haoyu_meng@163.com |
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| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 26320110 | Background | Roffi M, Patrono C, Collet JP, Mueller C, Valgimigli M, Andreotti F, Bax JJ, Borger MA, Brotons C, Chew DP, Gencer B, Hasenfuss G, Kjeldsen K, Lancellotti P, Landmesser U, Mehilli J, Mukherjee D, Storey RF, Windecker S; ESC Scientific Document Group. 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC). Eur Heart J. 2016 Jan 14;37(3):267-315. doi: 10.1093/eurheartj/ehv320. Epub 2015 Aug 29. No abstract available. | |
| 28886621 |
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|
| 12 months |
| Stent restenosis | 12 months |
| Target vessel revascularization | 12 months |
| Major cardio-cerebral vascular events | Composite of any events from outcome 2 to 6 | 12 months |
| Background |
| Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, Caforio ALP, Crea F, Goudevenos JA, Halvorsen S, Hindricks G, Kastrati A, Lenzen MJ, Prescott E, Roffi M, Valgimigli M, Varenhorst C, Vranckx P, Widimsky P; ESC Scientific Document Group. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2018 Jan 7;39(2):119-177. doi: 10.1093/eurheartj/ehx393. No abstract available. |
| 7464234 | Background | Reeder GS, Lengyel M, Tajik AJ, Seward JB, Smith HC, Danielson GK. Mural thrombus in left ventricular aneurysm: incidence, role of angiography, and relation between anticoagulation and embolization. Mayo Clin Proc. 1981 Feb;56(2):77-81. |
| 2643772 | Background | Turpie AG, Robinson JG, Doyle DJ, Mulji AS, Mishkel GJ, Sealey BJ, Cairns JA, Skingley L, Hirsh J, Gent M. Comparison of high-dose with low-dose subcutaneous heparin to prevent left ventricular mural thrombosis in patients with acute transmural anterior myocardial infarction. N Engl J Med. 1989 Feb 9;320(6):352-7. doi: 10.1056/NEJM198902093200604. |
| 8821415 | Background | Keeley EC, Hillis LD. Left ventricular mural thrombus after acute myocardial infarction. Clin Cardiol. 1996 Feb;19(2):83-6. doi: 10.1002/clc.4960190203. |
| ID | Term |
|---|---|
| D000925 | Anticoagulants |
| ID | Term |
|---|---|
| D006401 | Hematologic Agents |
| D045506 | Therapeutic Uses |
| D020228 | Pharmacologic Actions |
| D020164 | Chemical Actions and Uses |
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