Left ventricular thrombosis and arterial embolism after thrombolysis in acute anterior myocardial infarction: predictors and effects of adjunctive antithrombotic therapy

The prevalence of left ventricular (LV) thrombosis and incidence of arterial embolism after acute anterior myocardial infarction (AAMI) treated with streptokinase 1.5 × 106 IU intravenously was studied in 136 patients enrolled consecutively in five cardiological centres. Adjunctive antithrombotic th...

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Bibliographic Details
Published in:European heart journal 1993-11, Vol.14 (11), p.1489-1492
Main Authors: KONTNY, F., DALE, J., HEGRENÆS, L., LEM, P., SØBERG, T., MORSTØL, T.
Format: Article
Language:English
Subjects:
Acute myocardial infarction
Age Factors
arterial embolism
Aspirin - administration & dosage
Biological and medical sciences
Blood. Blood coagulation. Reticuloendothelial system
Echocardiography
Embolism - etiology
Heart Diseases - etiology
Heart Diseases - prevention & control
Heart Failure - etiology
Heart Ventricles - physiopathology
Heparin - administration & dosage
Humans
left ventricular thrombosis
Medical sciences
Middle Aged
Myocardial Infarction - complications
Myocardial Infarction - drug therapy
Myocardial Infarction - physiopathology
Pharmacology. Drug treatments
Regression Analysis
Streptokinase - administration & dosage
thrombolytic therapy
Thrombolytic Therapy - methods
Thrombosis - etiology
Thrombosis - prevention & control
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Summary:The prevalence of left ventricular (LV) thrombosis and incidence of arterial embolism after acute anterior myocardial infarction (AAMI) treated with streptokinase 1.5 × 106 IU intravenously was studied in 136 patients enrolled consecutively in five cardiological centres. Adjunctive antithrombotic therapy was administered according to the routine of each centre. Thrombus formation was studied by two-dimensional echocardiography, and events of arterial embolism recorded. LV thrombosis was found in 37 (27.2%) of the patients. In a subgroup of 53 patients receiving post-thrombolytic therapy with acetylsalicylic acid only, a thrombus developed in 14 (26.4%). The thrombus prevalence among patients given high-dose heparin was significantly lower than among those receiving either low-dose heparin or no heparin (4/30 vs 33/106, P = 0.045). Logistic regression analysis suggested that severe LV wall motion abnormality (P & 0.001) and avoidance of treatment with high-dose heparin(P = 0.023) were independent predictors of LV thrombus formation. Only one patient (0.7%) suffered arterial embolism (ischaemic stroke). In conclusion, LV thrombosis is frequent after thrombolytic therapy for AAMI, and impaired LV wall motion represents an independent predisposing factor. Low-dose heparin and acetylsalicylic acid seem less effective for LV thrombus prophylaxis than high-dose heparin. The incidence of arterial embolism is low.
ISSN:0195-668X
1522-9645
DOI:10.1093/eurheartj/14.11.1489