Clinical Study Of Dual Channel Antithrombotic Therapy In Acute Anterior Myocardial Infarction

Background According to current clinical studies,many cardiovascular adverse events still occur in the treatment of traditional dual antiplatelet therapy(DAPT),especially the incidence of high-risk patients is significantly increased.Through long-term follow-up,it is found that nearly 10% of the optimal DAPT patients still have major cardiovascular events,especially the incidence of left ventricular thrombosis up to 15%.Among them,the incidence of acute anterior myocardial infarction is as high as34%-57%.Although DAPT combined with oral anticoagulant drugs such as rivaroxaban can effectively reduce left ventricular thrombosis,the bleeding risk is increased by 3-4 times compared with DAPT.Corresponding clinical studies have shown that,on the basis of triple antithrombotic therapy,reducing aspirin does not lead to an increase in ischemic events.In addition,the risk of bleeding was significantly reduced.In the current trial,it was suggested that dual anticoagulant[vitamin K antagonist(VKA)plus clopidogrel] was superior to triple aspirin antithrombotic therapy in the treatment of LVT after AMI.Studies have shown that rivaroxaban combined with tigrelor is similar to DAPT,but with a lower risk of bleeding.Recent relevant studies have confirmed that low-dose rivaroxaban combined with dual antiplatelet drugs can effectively prevent the occurrence of acute anterior myocardial infarction LVT without significantly increasing the risk of bleeding.Meanwhile,it was found that the clinical net benefit was increased,but the application time was short(1 month),and the clinical adverse events were reversed after withdrawal.This study was intended to evaluate the efficacy of long-duration(3 months)ticagrelor combined with low-dose rivaroxaban dual-channel therapy in patients with acute anterior myocardial infarction.However,there is still no evidence of the efficacy and safety of dual-channel therapy in preventing left ventricular thrombosis in patients with acute anterior myocardial infarction after emergency PCI.Objectives:In this study,dual-channel therapy was adopted to prevent the formation of left ventricular thrombosis in patients with acute anterior myocardial infarction undergoing emergency PCI.Through this prospective clinical study,the randomized controlled method was adopted to determine the safety and effectiveness of dual-channel antithrombotic therapy for the prevention of left ventricular thrombosis in acute anterior myocardial infarction.And to evaluate the effect rate of DAPT and ticagrelor combined with rivaroxaban on left ventricular thrombosis and cardiovascular MACCE events.Methods:Random number table method was used to divide emergency PCI patients with acute anterior myocardial infarction who met the inclusion criteria but did not meet the exclusion criteria into two-channel group and control group.Patients in both groups who met the inclusion criteria but did not meet the exclusion criteria were initially given traditional dual antiplatelet therapy after admission.At the same time,according to the patients’ vascular lesions,Consider whether low molecular weight heparin anticoagulation should be given as appropriate;Later dual-channel group: Some patients still needed secondary PCI during hospitalization,so some patients stopped low molecular weight heparin anticoagulant therapy after secondary PCI(if no secondary PCI was needed,low molecular weight heparin therapy was stopped and dual-channel therapy was replaced;If low molecular weight heparin was not given after surgery,direct dual-channel therapy could be used),rivaroxaban(2.5mg 2/ day)combined with ticagrelor(90mg 2/ day)for 3months,and then replaced with dual antiplatelet therapy for 9 months.Control group: During hospitalization,patients were treated with dual antiplatelet therapy(aspirin 100mg+ ticagrelor 90mg)for 1 year.During the hospital period,I improved cardiac color 1 week after PCI,and informed patients through wechat follow-up group or telephone to conduct regular postoperative follow-up in the Department of Cardiology outpatient department on time 1 month and 3 months after surgery,and observed the formation of left ventricular thrombosis with cardiac color.Routine examination,death,stroke and TIA,recurrent myocardial infarction,systemic embolism,thrombotic adverse events and bleeding events were also included in the follow-up one month and three months after surgery.Results:Analysis of general basic information between the two-channel group and the control group showed that there was no significant difference in age,sex,body mass index,history of stroke and TIA,history of hyperlipidemia,history of myocardial infarction,history of diabetes,history of hypertension,history of smoking,Killip grade,history of PCI,and other related cardiovascular medications between the two groups.Compared with patients in the control group,the probability of left ventricular thrombosis after emergency PCI for prevention of acute anterior myocardial infarction after dual-channel therapy was significantly reduced,the incidence of thrombotic adverse events was significantly decreased,and the incidence of combined endpoint events(thromboembolic adverse events and clinical death)was significantly decreased,while the overall incidence of bleeding events was not statistically significant.Conclusion:1.Dual channel antithrombotic therapy can significantly reduce the rate of left ventricular thrombosis;2.Dual-channel antithrombotic therapy can significantly reduce the incidence of adverse thrombotic events;3.Dual-channel antithrombotic therapy significantly reduced the incidence of combined endpoint events(thromboembolic adverse events and clinical death);4.The incidence of thrombotic adverse events and clinical death was not statistically significant compared with traditional dual antiplatelet therapy.In conclusion,the application of dual-channel antithrombotic therapy in acute anterior myocardial infarction is safe and effective in preventing the formation of left ventricular thrombosis.