Safety Evaluation Of The Prognosis Of Patients With Prophylactic Anticoagulation Therapy For Left Ventricular Dysfunction After PCI For Acute Myocardial Infarction

Objective:To evaluate the efficacy and safety of prophylactic anticoagulation in patients with left ventricular dysfunction after PCI for acute myocardial infarction,to provide reference for clinical selection of anticoagulant therapy.Methods:The relevant documents from January 1990 to February 2020 in PubMed,CNKI,Wanfang database knowledge service platform and VIP journal database were searched by computer.According to the inclusion criteria and exclusion criteria,literature selection is completed.This process is carried out in note Express software,and Review Manager 5.3 software is used for post-processing data.Result:According to the inclusion criteria,the analysis results are as follows:(1)the incidence of cardiovascular and cerebrovascular events in patients with acute myocardial infarction after PCI was treated with preventive anticoagulant therapy,a total of 1033patients were included,380 patients were treated with triple therapy(double antiplatelet therapy+anticoagulant therapy),among which 16 patients had cardiovascular and cerebrovascular events such as LVT/stroke/reinfarction,there were 653 patients with dual antiplatelet therapy and 13 patients with LVT/stroke/reinfarction.Heterogeneity test:I~2=0%,no heterogeneity.Fixed effect model was used.The results showed that:or=2.20,95%CI:1.04-4.64,P=0.04,the difference was statistically significant;(2)the incidence of massive hemorrhage after PCI in patients with acute myocardial infarction treated with preventive anticoagulation:a total of 1033 patients were included,380patients were treated with triple therapy(double antiplatelet therapy+anticoagulation therapy),among which 20 patients had major bleeding events,653 patients were treated with dual therapy(double antiplatelet therapy),among which 8 patients had major bleeding events,I~2=0%was considered as no heterogeneity,and fixed effect model was used.The results showed that:or=4.52,95%CI:2.05-9.98,P<0.0001,the difference was statistically significant;(3)All cause mortality of PCI patients with acute myocardial infarction after preventive anticoagulation:899 patients were included,326 of them were treated with triple therapy,19 of them died,563 of them were treated with dual therapy,14 of them died,I~2=49%.It was considered that there was no heterogeneity,and fixed effect mode was used.The results showed that:or=2.17,95%CI:1.08-4.37,P=0.03,the difference was statistically significant.Conclusion:1.The mortality of patients with left ventricular dysfunction after PCI was higher than that of patients with dual antiplatelet therapy;2.The risk of cardiovascular and cerebrovascular events such as stroke,reinfarction and LVT in patients with left ventricular dysfunction after PCI is still high;3.Compared with the double antiplatelet therapy,the incidence of massive hemorrhage after PCI was significantly higher.