Anticoagulant therapy after acute anterior myocardial infarction in elderly patients

Background: The purpose of the study was to evaluate the usefulness of anticoagulant treatment after acute anterior myocardial infarction (AMI) for the prevention of embolic events in the elderly. Methods: Two hundred and nine patients with AMI admitted during three consecutive years were reviewed. We analyzed embolic events during a 3-month postdischarge follow-up acid noted the presence of drug-induced adverse effects. Two groups of patients were compared: group A (< 65 years old: 82 men, 12 women; mean age +/- SD 54 +/- 12 years) and group B (greater than or equal to 65 years old: 68 men, 47 women; 75 +/- 8 years). Results: Embolic events were more common in the elderly patients (2.1% versus 8.6%, P < 0.1). Mural thrombus was correlated with more embolic events in both groups (A: 67% versus 0%, 8: 50% versus 6%; P < 0.001). Patients with mural thrombus who received anticoagulant treatment suffered fewer embolic events (A: 0% versus 66.6%, B: 0% versus 50%; P < 0.05), and there was no significant difference in drug-induced adverse effects between the two groups (3.7% versus 14.2%, NS). Elderly patients were less likely to receive anticoagulant treatment than were younger patients (56.3% versus 24.3%, P < 0.05). Conclusions: In elderly patients who have mural thrombus after AMI, anticoagulant treatment is correlated with fewer embolic events, but elderly patients are less likely to receive anticoagulation than are younger ones.