DYNAMICS OF LEFT-VENTRICULAR THROMBI IN PATIENTS WITH ACUTE ANTERIOR MYOCARDIAL-INFARCTION TREATED WITH THROMBOLYTICS

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.