T. Mooe et al., DYNAMICS OF LEFT-VENTRICULAR THROMBI IN PATIENTS WITH ACUTE ANTERIOR MYOCARDIAL-INFARCTION TREATED WITH THROMBOLYTICS, Coronary artery disease, 6(9), 1995, pp. 703-707
Background: Limited data exist concerning left ventricular thrombi dur
ing and after hospitalization in patients treated according to modern
principles. The purpose of the present study was to examine the format
ion and resolution of left ventricular thrombi during the first month
in patients with acute anterior myocardial infarction treated with str
eptokinase and aspirin. Methods: Seventy-seven consecutive patients we
re studied prospectively during the hospital stay and 1-month follow-u
p study. Aspirin was used routinely, whereas anticoagulants were only
used after a decision by the attending physician. Echocardiography was
performed within 3 days of admission, before hospital discharge and a
fter 1 month of follow-up. Results: At the first examination, 17 of 77
patients (22%) had a thrombus. At discharge, 73 patients remained in
the study. In five (31%) of the 16 patients with early thrombus, the t
hrombus persisted; in 18 (32%) of the 57 patients without early thromb
us, a new thrombus was diagnosed. One month later, 65 patients remaine
d eligible for follow-up study. In three of 20 patients (15%) the thro
mbus from the second examination persisted and in four of 45 patients
(9%) a new thrombus was diagnosed. The disappearance rate between the
second and third examination was high irrespective of whether patients
were treated with anticoagulants (eight of nine, 89%) or not (nine of
11, 82%). Extensive left ventricular segmental dysfunction and signs
of congestive heart failure were associated with the appearance of a l
eft ventricular thrombus. No embolic events were recorded. Conclusion:
In patients with anterior myocardial infarction treated with streptok
inase and aspirin the development and disappearance of left ventricula
r thrombi is a highly dynamic process. A large proportion of thrombi r
esolve without additional anticoagulant therapy.