Rationale of Anticoagulation Prolongation versus No Anticoagulation after Primary Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction

Abstract

Background: ST-elevation myocardial infarction (STEMI) results from the occlusion of coronary arteries, with plaque rupture being a common cause. Anticoagulant therapy is crucial during primary percutaneous coronary intervention (PPCI) for STEMI, yet the efficacy and  safety of postprocedure anticoagulation (PPAC) remain debated due to limited data and unclear guidelines.

Objective: This study  aimed to evaluate the rationale of anticoagulation prolongation versus no anticoagulation after pPCI for STEMI.

Subjects and Methods: This randomized controlled clinical study was performed at the Cardiology Department of the Nasser Institute  for Research and Treatment. Ninety-seven STEMI patients undergoing PPCI were randomly assigned to two groups: 49 patients received  no subcutaneous low molecular weight heparin (LMWH) after PPCI (Group 1), and 48 patients received subcutaneous LMWH (Group 2).  The parameters assessed included demographic data, clinical examination findings, laboratory investigations, ECG, echocardiography,  and PCI findings.

Results: This study found no significant differences in baseline characteristics, vital signs, clinical examination outcomes, and most procedural characteristics between the groups. However, a significant difference was observed in the occurrence of  left ventricular (LV) thrombus, with 8.2% of group 1 exhibiting LV thrombus compared to none in group 2 (P = 0.043). There were no  significant differences in follow-up outcomes, including acute heart failure, bleeding, hemodynamically unstable arrhythmia, ischemic  thrombus, stroke, myocardial infarction, and death.

Conclusions: Prolonged postprocedural anticoagulation after PPCI for STEMI  significantly reduced in-hospital morbidity and the risk of LV thrombus without increasing bleeding risks. This suggests a superior  efficacy of post-PPCI anticoagulation in mitigating ischemic events.