Left ventricular thrombi after short-term high-dose anticoagulants in acute myocardial infarction.
To examine the effect of short-term, high-dose anticoagulation on the subsequent occurrence of left ventricular (LV) thrombi after a first anterior wall acute myocardial infarction (AMI), 21 patients received placebo and 21 high-dose anticoagulants during the first 10 days of the acute infarction. They were studied with cross-sectional echocardiography 10 days and 1.3 and 6 months post infarction. At 1 month, 6 of 7 thrombi present in the placebo group at 10 days were still visible. No thrombi were detected at 10 days in the anticoagulation group, but 6 patients had developed a LV thrombus at 1 month. These 12 patients with LV thrombi were subsequently treated with oral warfarin for 2 months, after which all thrombi had disappeared. Warfarin was then discontinued, and a thrombus had recurred in 5 patients after 6 months. Apical akinesis at 10 days was a predictor for thrombus with a sensitivity and specificity of 100% and 72.2%, respectively. Three of the 13 patients with LV thrombi suffered stroke in contrast to none without thrombi (P = 0.025). We conclude that after discontinuation of short-term high-dose anticoagulation therapy in anterior AMI, LV thrombi may develop rapidly and lead to embolic complications, particularly in patients with persisting apical akinesis.
Johannessen
K A
KA
Medical Department, Diakonissehjemmet Hospital, Bergen, Norway.
Nordrehaug
J E
JE
von der Lippe
G
G
D000925:Anticoagulants / Q000627:therapeutic use*; D004452:Echocardiography; D006331:Heart Diseases / Q000209:etiology* / Q000517:prevention & control; D006801:Humans; D009203:Myocardial Infarction / Q000150:complications* / Q000188:drug therapy; D011446:Prospective Studies; D011897:Random Allocation; D013927:Thrombosis / Q000209:etiology* / Q000517:prevention & control; D013997:Time Factors
D000925:Anticoagulants