左心室血栓是急性心肌梗死后的已知并发症,可导致全身性血栓栓塞。为了避免血栓栓塞的风险,除了双重抗血小板治疗外,患者还需要抗凝治疗.然而,抗血小板和抗凝剂联合使用会显著增加出血风险.传统上,在这种情况下,维生素K拮抗剂(VKAs)已成为抗凝的片锚。直接口服抗凝剂的使用显著降低了与房颤和静脉血栓栓塞的抗凝相关的出血风险。此外,在接受经皮冠状动脉介入治疗的房颤患者中,与VKA相比,直接口服抗凝药(DOACs)与抗血小板药物联合使用在减少缺血事件同时显著减轻出血方面效果不差.在最初的病例报告之后,目前,多项观察性和非随机研究已安全有效地利用直接口服抗凝剂治疗左心室血栓.这里,我们报道了2例急性心肌梗死后出现左心室血栓的病例。在这个系列中,我们试图解决梗死后左心室血栓的抗凝治疗选择和持续时间的问题。在大型随机对照试验的结果之前,在个体化治疗中考虑到缺血和出血情况时,明智使用直接口服抗凝剂是必要的.
Left ventricular thrombus is a known complication following acute myocardial infarction that can lead to systemic thromboembolism. To obviate the risk of thromboembolism, the patient needs anticoagulation in addition to dual antiplatelet therapy. However, combining antiplatelets with anticoagulants substantially increases the bleeding risk. Traditionally, vitamin K antagonists (VKAs) have been the sheet anchor for anticoagulation in this scenario. The use of direct oral anticoagulants has significantly attenuated the bleeding risk associated with anticoagulation for atrial fibrillation and venous thromboembolism. Furthermore, in patients with atrial fibrillation undergoing percutaneous coronary intervention, the use of direct oral anticoagulants (DOACs) in conjunction with antiplatelets has been found to be noninferior in reducing ischemic events while significantly attenuating the bleeding compared with VKA. After initial
case reports, multiple observational and nonrandomized studies have now safely and effectively utilized direct oral anticoagulants for anticoagulation in left ventricular thrombus. Here, we report a series of two cases presenting with left ventricular thrombus following acute myocardial infarction. In this
case series, we try to address the issues concerning the choice and duration of anticoagulation in the
case of postinfarct left ventricular thrombus. Pending the results of large randomized control trials, the judicious use of direct oral anticoagulant is warranted when taking into consideration the ischemic and bleeding profile in an individualized approach.