Warfarin After Anterior ST-Elevation Myocardial Infarction

• Status: Completed
• Trial end date: 2008-01-01
• Target enrollment: 0
• Participant gender: All

Summary

Following severe heart attacks involving the front wall of the heart (anterior myocardial infarction), patients are at risk of developing blood clots in the main pumping chamber that can cause a stroke. In the past, studies have shown that a blood thinner (warfarin) can decrease the risk of stroke and clot formation if administered to patients after an anterior myocardial infarction.

However, in today's current practice, certain heart attack patients are commonly treated with two blood-thinning medications (aspirin and clopidogrel) to prevent recurrent heart attacks.

Thus, a clinical problem is created as physicians are not clear how to treat patients after an anterior myocardial infarction who are at risk of a clot but require aspirin and clopidogrel to keep their blood vessels open. Adding warfarin to the combination of aspirin and clopidogrel will possibly decrease the risk of stroke but increase the risk of bleeding. Currently, there is no good evidence to help guide physicians. As demonstrated by a survey done at the Hamilton Health Sciences, there is a fifty/fifty split between physicians who use dual (aspirin and clopidogrel) versus triple (aspirin, clopidogrel, and warfarin) therapy in the treatment of similar patients as described above.

The purpose of this study is to address the bleeding and stroke complications in patients after a severe anterior myocardial infarction. Half of the eligible patients will receive dual therapy and half will receive triple therapy. We will compare the incidence of stroke, blood clots, and bleeding complications between the two groups at 3 months.

• Phase: N/A
• Accepts Healthy Volunteers?: No

Details

• Lead Sponsor: Hamilton Health Sciences Corporation
• Treatments: Aspirin; Clopidogrel; Ticlopidine; Warfarin

Criteria

Inclusion Criteria:

• Anterior STEMI

• An ejection fraction less than 40% as per initial LV angiography or echocardiogram

• Randomization possible within hospital admission if anticoagulated with no interruption > 24 hours

• Patient able and willing to give informed consent to participate in this trial

Exclusion Criteria:

• history of intracranial hemorrhage

• history of GI bleed last 6 months

• hemoglobin < 90 g/L

• platelet count < 100 x 10exp9/L

• ischemic stroke last 30 days

• intracranial tumor or aneurysm

• significant pericardial effusion

• severe renal failure (creatinine > 250 mmol/L).