Treatment Drug-Eluting Stent
ÎFor patients with anterior MI and LV thrombus, or at high risk for LV thrombus (ejection fraction < 40%, anteroapical wall motion abnormality) who undergo DES placement:
• The ACCP suggests triple therapy (warfarin [INR 2.0-3.0], low-dose aspirin, clopidogrel 75 mg daily) for 3 to 6 months over alternative regimens and alternative durations of warfarin therapy (2-C).
• Thereafter, the ACCP recommends discontinuation of warfarin and continuation of dual antiplatelet therapy for up to 12 months as per ACCP recommendations for ACS. After 12 months, antiplatelet therapy is recommended as per established ACCP recommendations for CAD.
Figure 3. Anterior MI & LV Thrombus
Anterior MI & LV Thrombus
Systolic LV dysfunction
≥ 3 mo
Warfarin (INR 2.0-3.0) × ≥ 3 mo
Warfarin (INR 2.0-3.0) and aspirin 75-100 mg daily
3 mo Discontinue warfarin BMS 2 mo
Warfarin (INR 2.0-3.0) and single antiplatelet Rx
Dual antiplatelet Rx ≤ 12 mo
Single antiplatelet Rx No stent 2 mo BMS 1 mo DES 3-6 mo
Aspirin 75-375 mg and clopidogrel 75 mg daily
Then DES
