LEFT-VENTRICULAR THROMBUS FORMATION AND RESOLUTION IN ACUTE MYOCARDIAL-INFARCTION

Left ventricular thrombus formation and resolution were studied by ser ial echocardiography in 38 patients with acute anterior myocardial inf arction. Twenty (52.6%) patients developed thrombus. Cumulative rates were: 12/20 (60%) at 24 h (+/-24 h), 17/20 (85%) at 72 h (+/-24 h), an d 19/20 (95%) at 120 h (+/-24 h). Early thrombus formation was associa ted with worse left ventricular wall motion relative to those with del ayed thrombus development (P=0.00016). in patients with initially norm al echocardiograms, subsequent thrombus formation was associated with wall motion deterioration (P=0.016). A thrombus occurred in 16/28 (57. 1%) patients given streptokinase. Heparin and warfarin were given in c ase of thrombus formation. Among survivors with thrombus,resolution oc curred with a cumulative rate of 1/18 (5.6%) at 72 h (+/-24 h), 2/18 ( 11.1%) at 120 h (+/-24 h), 10/18 (55.6%) at 3 months (+/-1 week) and 1 6/18 (88.9%) at 6 months (+/-1 week). No embolic events occurred. Left ventricular thrombus formation occurs often and early after acute ant erior myocardial infarction, even when streptokinase is given. Delayed thrombus formation is associated with wall motion deterioration. Thro mbus resolution occurs frequently during anticoagulation and seems not associated with increased embolic risk. (C) 1998 Elsevier Science Ire land Ltd. All rights reserved.