Embolic potential, prevention and management of mural thrombus complicating anterior myocardial infarction: A meta-analysis

Vaitkus, Paul T.; Barnathan, Elliot S.

doi:10.1016/0735-1097(93)90409-t

Cited by 366 publications

(244 citation statements)

References 43 publications

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“…Although no randomized control trial data exist, in a meta-analysis that included 270 patients with anterior myocardial infarction and documented LV thrombus, anticoagulation (compared to no anticoagulation) was associated with an 86 percent reduction in the rate of embolization. 21 Based on these findings, the 2012 American College of Chest Physicians Guidelines on Antithrombotic Therapy and Prevention of Thrombosis Guidelines recommends the use of warfarin for at least 3 months with a goal international normalized ratio of 2.0e3.0, followed by patientselective decisions to continue antico-agulation. 22 In conclusion, this case of unrecognized myocardial infarction in the setting of blunt chest trauma highlights the importance of careful consideration of cardiac injury in the emergency setting.…”

Section: What Might Lead To a Missed Diagnosis Of This Condition?mentioning

confidence: 99%

Cardio-embolic stroke following remote blunt chest trauma

Arora

Atreya

Penumetsa

et al. 2013

Journal of Cardiovascular Disease Research

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a b s t r a c tA cardio-embolic stroke as a sequela of remote blunt chest trauma is a rare clinical presentation. Blunt chest trauma can cause various acute cardiac complications like arrhythmias, cardiac contusion etc. However, delayed consequences such as left ventricular thrombus resulting in thromboembolic phenomena are reported infrequently.A 30-year-old healthy man presented to an outside facility with transient neurological deficits. An MRI brain showed lesions suggestive of embolic etiology. A trans-thoracic echocardiogram (TTE) showed a 1.5 Â 1.5 cm mass present in the left ventricular (LV) apex. Patient was transferred to our institution for cardiac surgery evaluation. On detailed questioning, he reported an incident of blunt chest trauma during a martial arts exhibition fight that took place 2 years back. Given this history, a cardiac catheterization was done, which showed 30% stenosis in mid-left anterior descending artery (LAD) without any other significant obstructive lesion. A trans-esophageal echocardiogram (TEE) showed akinesis of the LV apex and confirmed TTE finding of a mass, consistent with an apical thrombus. Surgery was deferred and patient was started on anticoagulation. A cardiac MRI done 2 weeks later showed evidence of apical infarction in the LAD territory.LAD is the most commonly affected coronary vessel by blunt traumatic injuries, likely due to its vulnerable anatomical position on the anterior aspect of the heart. A variety of mechanisms including intimal tear, rupture and spasm have been implicated in the pathogenesis of myocardial infarction after blunt chest trauma.

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Section: What Might Lead To a Missed Diagnosis Of This Condition?mentioning

confidence: 99%

Cardio-embolic stroke following remote blunt chest trauma

Arora

Atreya

Penumetsa

et al. 2013

Journal of Cardiovascular Disease Research

View full text Add to dashboard Cite

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“…LV thrombi are clinically important because of their ability to embolize [25,26]. In fact, patients who develop mural thrombi after MI have a poor prognosis, including a 10% rate of systemic embolization [27].…”

Section: Thrombusmentioning

confidence: 99%

Technological Improvements in Cardiac Thrombus Diagnosis

Hur

Hong

et al. 2017

Cardiovasc Imaging Asia

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Cardiovascular imaging technology constantly evolves and provides more testing options for evaluating cardiovascular morphology and function. Accurate detection and diagnosis of cardiac thrombi are important in clinical practice, as they provide a substrate for embolic events and a rationale for anticoagulation therapy. Echocardiography, predominantly transesophageal echocardiography, has been used as a reference modality to assess flow stasis and cardiac thrombus. Cardiac computed tomography (CCT) and cardiac magnetic resonance imaging (CMRI) have also been proposed and tested as alternative imaging modalities for cardiac thrombus detection. Given the noninvasive nature of CCT and CMR, developing strategies based on these modalities for the detection of cardiac thrombi and flow stasis is of great clinical interest. However, these advanced imaging techniques should add value in the clinical setting.

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“…The cause of MI was spontaneous coronary artery disection, which was managed conservatively without stenting because there was no evidence for ongoing myocardial ischemia, and there is no established benefit from antiplatelet therapy for this indication [1]. Dabigatran was chosen to treat the LV mural thrombus because in the RE-LY trial [2] the risk of intracranial haemorrhage was lower for patients treated with dabigatran compared to warfarin, and the estimated 10-15% thromboembolic risk from the mural thrombus [3] was thought to be greater than the low risk of further intracranial bleeding >1 week after a traumatic SAH [4].…”

Section: Introductionmentioning

confidence: 99%