This handout is for anterior wall stemi (lad culprit). Your care team identified this based on: st elevation v1–v6 + reciprocal st↓ inferior leads (anterior stemi).
Other reasons your team may use this plan: ischemic chest pain + anterior stemi ecg → emergent cath within 90 min; new severe lv dysfunction on bedside echo + anterior wall akinesia.
Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.
| Medication | Starting dose | How | When | What it does |
|---|---|---|---|---|
| aspirin | 162-325 mg chewed | PO | load + 81 mg daily | ACC/AHA 2025 ACS Class I; same as parent |
| ticagrelor | 180 mg load → 90 mg BID | PO | BID × 12 mo default DAPT | PLATO PMID 19717846; same as parent |
| warfarin | 5 mg daily; INR target 2-3 | PO | daily | Standard 3-mo warfarin if LV thrombus per AHA 2022 Class IIa; consider DOAC alternative (apixaban) for compliance per COMMANDER-HF (PMID 30277645) — though direct LV-thrombus DOAC RCT data sparse |
| apixaban | 5 mg BID (or 2.5 mg BID per dose-reduction criteria) | PO | BID × 3 mo for LV thrombus | Off-label-but-rational DOAC alternative for LV thrombus; small RCTs (NoT-DAPT, Xarelto LV-thrombus) suggest non-inferiority to warfarin |
Plan: Anterior STEMI complication phenotype — adds to parent cardio.stemi.core.v1 reperfusion regimen
Contact your care team if any of the following happen:
Call 911 or go to the nearest emergency room right away if you have:
Cardiology + EP follow-up; heart pumping strength (LVEF) re-echo at 40-90 d for ICD eligibility (MADIT-II EF ≤30); WCD bridge during interval if EF <35; cardiac rehab
Guideline: 2025 ACC/AHA ACS Guideline + ESC 2023 ACS + AHA 2022 HF (with 2023 Focused Update)