title: To anticoagulate or not: implications for the management of patients with acute myocardial infarction complicated by both left ventricular thrombus and pericardial effusion.
abstract: We reviewed the clinical and echocardiographic characteristics of seven patients with left ventricular thrombus and pericardial effusion. Each patient had a recent anterior wall myocardial infarction with an apical left ventricular thrombus. Two patients had clinical evidence of pericarditis. On two-dimensional echocardiography, the effusion was judged to be small in five cases and moderate in two. All patients received parenteral heparin therapy; six of the seven patients subsequently received long-term oral anticoagulation therapy. None of the patients had any clinical or two-dimensional echocardiographic evidence of increasing pericardial effusion or tamponade. Documented systemic embolization was seen in only one patient, whose anticoagulant therapy was stopped 2 weeks after myocardial infarction. In five patients, repeat two-dimensional echocardiography was performed from 2 to 4 months after infarction; in four patients, neither pericardial effusion nor left ventricular thrombus was found. In this group of patients, both short- and long-term anticoagulants were safely administered despite pericardial effusion.
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D004452:Echocardiography; D006331:Heart Diseases / Q000188:drug therapy*; D006352:Heart Ventricles; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000188:drug therapy; D010490:Pericardial Effusion / Q000188:drug therapy*; D012189:Retrospective Studies; D013927:Thrombosis / Q000188:drug therapy*
chemical_list: D000925:Anticoagulants; D006493:Heparin