Anticoagulant therapy with dual antiplatelet for left ventricular thrombus following acute myocardial infarction

Two men aged 71 and 62 years were admitted for ST elevation myocardial infarction and percutaneous coronary intervention was performed to the occlusion of left anterior descending artery. Echocardiogram showed an akinetic or a dyskinetic movement of left ventricular anterior wall with mural thrombus on admission in Case 1 and 10 days from admission in Case 2. A direct oral anticoagulant (DOAC) in addition to dual antiplatelet therapy (DAPT) in both patients was started successfully for the resolution of left ventricular thrombus 3 weeks after the initiation of DOAC in Case 1, and 2 weeks after the initiation of DOAC in Case 2. However, the dose of DOAC was decreased and aspirin was stopped in Case 1 with HAS-BLED score five due to colon polyp bleeding, and there was no bleeding complication in Case 2 with HAS-BLED score two during this triple therapy. The duration of triple therapy was 2 months in Case 1 and 6 months in Case 2, and of DOAC therapy was total 6 months in both cases. <Learning objective: Anticoagulant in addition to dual antiplatelet therapy (DAPT) is necessary for left ventricular thrombus following acute myocardial infarction. However, this triple therapy is generally associated with significant bleeding hazard. We here show the efficacy of direct oral anticoagulant on left ventricular thrombus and the necessity of regimes for duration of triple therapy which should be carefully considered according to the patient characteristics. Recent stent design may allow briefer duration of DAPT for the reduction of bleeding complication.>.