What is a reasonable length of time for systemic anticoagulation in patients presenting with MI in the setting of coronary artery aneurysm with large thrombus formation?
This is a great question. I would make the following points in reply:
- The present standard of care for antithrombotic therapy after a type 1 acute myocardial infarction, with coronary thrombosis, is dual antiplatelet therapy for one year (preferentially including a potent P2Y12 inhibitor). Current e...
In the setting of one event (MI) and an obvious source of the event (thrombus burden in an aneurysmal coronary), logic may dictate lifelong AC, to prevent recurrence. But then again, this is logic dictating the practice of medicine, due to extreme paucity of data on the subject.
Obviously, there are no clinical trials that answer this question directly. Most clinicians have only a handful of such cases in their experience. I’ve personally aimed for lifelong anticoagulant therapy although at some point - at least 6 months - switching to an antiplatelet maintenance-based regi...
I have encountered about 4 cases of this particular problem in my clinical practice. I would recommend long-term anti-coagulation for these cases. As there is no real data on this topic, most of the knowledge is from case reports.
The initiation of a thrombotic event is aggravated by aneurysm and slow flow, while platelet aggregation eventually will set in during a full-blown thrombotic type 1 MI. With various NOACs and good consistent bioavailability, in a tolerating patient once the coronary flow is restored it is reasonabl...