Concurrent Coronary, Left Ventricle, and Cerebral Thrombosis - A Trilogy

Left ventricular (LV) thrombus is a known complication of acute myocardial infarction (AMI), especially anterior wall MI and leads to systemic thromboembolism. However, increase in the rates of coronary perfusion either by thrombolysis or percutaneous interventions have reduced its incidence. Concurrent stroke and MI are seen in 0.009% of cases. The occurrence of AMI with LV thrombus with or without stroke mandates the combination of antiplatelet and antithrombotic therapy. Hitherto, there are no randomized studies in the setting of AMI with LV thrombus comparing dual (single antiplatelet plus oral anticoagulant [OAC]) and triple therapy (dual antiplatelet therapy with OAC). There are no large randomized trials as well to delineate the optimal therapy for simultaneous cardiac and cerebral infarction. We hereby, report an unusual case of a young patient who presented with triple combo of acute anterior wall MI, LV thrombus, and ischemic stroke and discuss the challenges in management in this scenario.