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Thromboembolism in patients with decreased left ventricular function: incidence, risk, and treatment
1Krannert Institute of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, 46202, USA.
Insights
Intracavitary thrombus occurs in 11-44% of idiopathic dilated cardiomyopathy patients, with embolism risk up to 20%. Acute anterior myocardial infarction also risks thrombus formation (21-41%) and embolism (2-6%), especially with mobile thrombi.
Area of Science:
- Cardiology
- Internal Medicine
Background:
- Intracavitary thrombus is a known complication in idiopathic dilated cardiomyopathy (11-44%) and after acute anterior myocardial infarction (21-41%).
- Embolism risk associated with intracavitary thrombus ranges from 11-20% in dilated cardiomyopathy and 2-6% in acute anterior myocardial infarction.
Purpose of the Study:
- To review the incidence of intracavitary thrombus and embolism in specific cardiac conditions.
- To highlight the risk factors for embolization, such as protruding or mobile thrombi.
- To provide guidance on anticoagulation therapy for patients with dilated cardiomyopathy.
Main Methods:
- Literature review and synthesis of existing data on intracavitary thrombus and embolism.
- Analysis of incidence rates and risk factors in patients with idiopathic dilated cardiomyopathy and acute anterior myocardial infarction.
- Review of current recommendations for systemic anticoagulation.
Main Results:
- Incidence of intracavitary thrombus in idiopathic dilated cardiomyopathy is 11-44%, with embolism occurring in 11-20%.
- Acute anterior myocardial infarction shows intracavitary thrombus formation in 21-41% and embolism risk of 2-6%.
- Protruding or mobile thrombi significantly increase the risk of embolization.
Conclusions:
- Intracavitary thrombus is a significant concern in both idiopathic dilated cardiomyopathy and post-acute anterior myocardial infarction.
- Anticoagulation therapy, targeting an international normalized ratio of 2.0-3.0, is recommended for patients with dilated cardiomyopathy.
- Risk stratification for embolism should consider thrombus characteristics like mobility.
Abstract:
Intracavitary thrombus is noted in 11-44% of patients with idiopathic delayed cardiomyopathy, and the incidence of embolism is 11-20%. The incidence of intracavitary thrombus formation after acute anterior myocardial infarction is 21-41%. The risk of embolism in all patient with acute anterior myocardial infarction is 2-6%; protruding or mobile thrombi carry a risk of embolization. Systemic anticoagulation is justified in patients with dilated cardiomyopathy (international normalized ratio 2.0-3.0).