Analysis Of Antithrombotic Therapy In Patients With Myocardial Infarction Complicated With Left Ventricular Thrombus

Objective Analyze the use of triple antithrombotic therapy in myocardial infarction (MI) patients who complicated with left ventricular thrombus (LVT), and investigate the efficacy and safety of triple therapy.Methods The MI inpatients in The First Affiliated Hospital of School of Medicine in Zhejiang University between January 2008 and December 2009 were reviewed, and the patients who complicated with LVT were selected. According to their different oral medication exposure, the patients were divided into two groups:triple antithrombotic therapy (TT. warfarin plus aspirin and clopidogrel) and dual antiplatelet therapy (DT. aspirin plus clopidogrel). All patients were interviewed through telephone call, and the information about bleeding and other clinical events during the treatment period were collected and analvzed. Results In The First Affiliated Hospital of School of Medicine in Zhejiang University, there were 12 MI patients who complicated with LVT between January 2008 and December 2009. One of them died in 5 days after MI because of severe heart failure, one died in 5 months after discharged because of bladder cancer, one was out of contact, seven patients received triple antithrombotic therapy and the other two received dual antiplatelet therapy. In TT group, six (6/7) patients'LVT disappeared in 3 months, and the other one's (1/7) LVT disappeared after treating for five months. In DT group, two (2/2) patients'LVT disappeared at the 5th months. Most of these patients (2 in DT and 6 in TT) received a short-term (4-7 days) nadroparin therapy for anticoagulation. The international normalized ratio (INR) in TT group in hospital was at the range of 1.91～2.83, and the INR of patients when undergoing triple therapy in three months after discharged was 2.25～2.79. There was no major bleeding or ischemic event happened in both two groups, except one sudden death in TT group.Conclusion Triple antithrombotic therapy (no more than 3 months) might be safe and effective to MI patients who complicated with LVT, and the good control of INR is very important to help reducing the bleeding risk of triple therapy.