Related Experiment Video
Updated: Jun 24, 2025
Cardiac Magnetic Resonance for the Evaluation of Suspected Cardiac Thrombus: Conventional and Emerging Techniques
Published on: June 11, 2019
A Difficult Case of Cardio-Cerebral Infarction Syndrome With Left Ventricular Thrombus
Xiong Khee Cheong1, Juen Kiem Tan1, Zarrin Kang2
1Internal Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, MYS.
Insights
Left ventricular thrombus after myocardial infarction can cause stroke. Optimal antiplatelet and anticoagulant therapy is crucial but challenging, especially after coronary intervention, balancing bleeding and clotting risks.
Area of Science:
- Cardiology
- Neurology
- Thrombosis Research
Background:
- Left ventricular thrombus (LVT) is a serious complication of myocardial infarction (MI), especially anterior MI or dilated cardiomyopathies.
- Mural thrombus embolization is a leading cause of large vessel occlusion ischemic stroke.
- Current guidelines mandate antiplatelet and anticoagulant therapy for MI with LVT, but optimal regimens for cardio-cerebral infarction are undefined.
Abstract:
Left ventricular thrombus is a major complication following myocardial infarction, particularly in patients with anterior myocardial infarction or dilated cardiomyopathies regardless of coronary reperfusion therapy. Embolization of mural thrombus is one of the major causes of large vessel occlusion ischemic stroke. A combination therapy of antiplatelet (single or dual antiplatelet) and anticoagulant is mandatory in the management of myocardial infarction and left ventricular thrombus with or without stroke. To our knowledge, there are no guidelines on the optimal regimen (dual or triple therapies) and timing of administration in cases of cardio-cerebral infarction. It is difficult for clinicians to balance the risks of intracranial hemorrhage and coronary stent thrombosis. Here, we describe the case of a gentleman who had recently undergone coronary intervention and presented with ischemic stroke and left ventricular thrombus, along with the management challenges in this scenario.
