Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2020, 164(1):34-42 | DOI: 10.5507/bp.2020.001

Acute myocardial infarction, intraventricular thrombus and risk of systemic embolism

Stepan Hudec^a, Martin Hutyra^a, Jan Precek^a, Jan Latal^a, Radomir Nykl^a, Miloslav Spacek^a, Martin Sluka^a, Daniel Sanak^b, Zbynek Tudos^c, Karel Navratil^d, Ludek Pavlu^a, Milos Taborsky

^a Department of Internal Medicine I - Cardiology, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University, Olomouc, Czech Republic

^b Comprehensive Stroke Center, Department of Neurology, University Hospital and Faculty of Medicine and Dentistry, Palacky University, Olomouc, Czech Republic

^c Department of Radiology, University Hospital and Faculty of Medicine and Dentistry, Palacky University, Olomouc, Czech Republic

^d Department of of Internal Medicine, Military Hospital, Olomouc, Czech Republic

The development of left ventricular thrombus (LVT) is a well-known and serious complication of acute myocardial infarction (AMI) due to the risk of systemic arterial embolism (SE), which is variable in its clinical picture and has potentially serious consequences depending on the extent of target organ damage. SE results in an increase in mortality and morbidity in these patients. LVT is one of the main causes of the development of ischaemic cardio-embolic cardiovascular events (CVE) after MI and the determination of the source of cardiac embolus is crucial for the initiation of adequate anticoagulant therapy in secondary prevention. Echocardiography holds an irreplaceable place in the diagnosis of LVT, contrast enhancement provides higher sensitivity. The gold standard for LVT diagnosis is cardiac magnetic resonance imaging, but it is not suitable as a basic screening test. In patients with already diagnosed LVT, it is necessary to adjust antithrombotic therapy by starting warfarin anticoagulation for at least 6 months with the need for echocardiographic follow-up to detect thrombotic residues. The effect of prophylactic administration of warfarin in high-risk patients after anterior AMI does not outweigh the risk of severe bleeding complications and does not result in a decrease in mortality and morbidity. At the present time, there is not enough evidence to use direct oral anticoagulants in this indication.

Keywords: left ventricular thrombus, ST segment elevation myocardial infarction, systemic arterial embolism, stroke, therapy

Received: June 28, 2019; Revised: December 5, 2019; Accepted: January 3, 2020; Prepublished online: January 31, 2020; Published: March 26, 2020  Show citation