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Left ventricular thrombi after short-term high-dose anticoagulants in acute myocardial infarction

K A Johannessen1, J E Nordrehaug, G von der Lippe

  • 1Medical Department, Diakonissehjemmet Hospital, Bergen, Norway.

European Heart Journal
|September 1, 1987
PubMed

Insights

Short-term anticoagulation after anterior myocardial infarction may lead to rapid left ventricular thrombi development. These thrombi can cause stroke, especially with persistent apical akinesis.

Area of Science:

  • Cardiology
  • Thrombosis Research

Background:

  • Left ventricular thrombi (LVT) are a complication of anterior acute myocardial infarction (AMI).
  • The impact of short-term, high-dose anticoagulation on LVT formation post-AMI requires investigation.

Purpose of the Study:

  • To assess the effect of short-term, high-dose anticoagulation on LVT occurrence after first anterior wall AMI.
  • To evaluate the relationship between LVT, subsequent embolic events, and echocardiographic findings.

Main Methods:

  • A randomized study comparing placebo (n=21) and high-dose anticoagulation (n=21) during the first 10 days post-AMI.
  • Cross-sectional echocardiography at 10 days, 1.3, and 6 months post-infarction.
  • Analysis of LVT predictors (apical akinesis) and embolic complications (stroke).

Main Results:

  • No LVT detected at 10 days in the anticoagulation group; 7/21 in placebo group.
  • LVT developed in 6/21 patients in the anticoagulation group by 1 month.
  • LVT resolved with warfarin but recurred in 5/12 patients after discontinuation.
  • Apical akinesis predicted LVT (100% sensitivity, 72.2% specificity).
  • Stroke occurred in 3/13 patients with LVT versus 0/11 without (P=0.025).

Conclusions:

  • Short-term anticoagulation cessation in anterior AMI can lead to rapid LVT development.
  • Persisting apical akinesis is a key predictor for LVT formation post-AMI.
  • LVT pose an embolic risk, highlighting the need for vigilant monitoring and management.

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