Left Ventricular Thrombus and Subsequent Thromboembolism, Comparison of Anticoagulation, Surgical Removal, and Antiplatelet Agents

Lee, Joo Myung; Park, Jin Joo; Cho, Young Seok; Oh, Il Young; Yoon, Chang Hwan; Suh, Jung Won; Chun, Eun Ju; Choi, Sang Il; Youn, Tae Jin; Lim, Cheong; Cho, Goo Yeong; Chae, In Ho; Park, Kay-Hyun; Choi, Dong Ju

doi:10.5551/jat.13540

Cited by 94 publications

(72 citation statements)

References 40 publications

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“…Although apical thrombus is a well-known complication of acute coronary syndrome, it is usually present in cases of acute anterior wall myocardial infarction with apical akinesia. 7) In our case, the cardiac apex was mildly hypokinetic. In the absence of other risk factors, the patient's hereditary predisposition to thrombosis is the main cause of the intracardiac thrombus.…”

Section: Discussionmentioning

confidence: 90%

A Young Male Patient With Multiple Thromboembolisms Associated With Factor V Leiden Mutation

et al. 2016

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SummaryFactor V Leiden (FVL) mutation is the most common hereditary thrombophilia. Association of this mutation with venous thrombosis is well established. However, there are several conflicting results regarding the association of FVL with arterial thrombosis, acute coronary syndrome, and intracardiac thrombosis. In this case report, we present a 44-yearold male patient with a medical history of both arterial and venous thrombosis who came to our emergency department with chest pain. After the initial evaluation he was diagnosed as having acute coronary syndrome and transthoracic echocardiography revealed an intracardiac apical thrombus. Coronary angiography showed non-critical stenosis. Thrombophilia panel was studied and the patient was found to be heterozygotic for FVL mutation. An apical thrombus was extracted surgically because of the high risk of systemic embolization. (Int Heart J 2016; 57: 654-656) Key words: Acute coronary syndrome, Intracardiac thrombus, Normal coronary arteries, Apical thrombus F VL mutation is the most common hereditary thrombophilia with a prevalence of heterozygous carriers of 3-5%. 1) Association of this mutation with venous thromboembolism is well established. However, there are conflicting data on the association between FVL with arterial thrombosis and acute coronary syndrome. Intracardiac thrombosis (ICT) is a rare clinical condition, except those associated with cardiomyopathies, atrial fibrillation, and post-infarction period.2) Rare causes of ICT are hereditary thrombophilias and other hypercoagulable states. Case ReportA 44 year-old male patient presented to the emergency department with worsening chest pain of 3 hours duration. His medical history revealed deep venous thrombosis in the left popliteal vein 4 years previously. He was on warfarin therapy then and 6 months later the therapy was stopped by his physician. Three months later he visited our emergency department complaining of sudden onset leg pain. Arterial Doppler ultrasonography revealed acute thrombus in the left popliteal artery and the patient underwent below knee peripheral by-pass surgery. After the surgery the patient was prescribed warfarin which he did not use. Physical examination revealed nothing important. His arterial blood pressure was 130/80 mmHg, Oxygen saturation was 98% at room air. His ECG showed 2 mm ST segment depression in leads V1 to V4. Routine blood tests were normal except elevated high sensitive cardiac troponin (342 ng/L, normal range: 0-34 ng/L) and CK-MB (48 µg/L, normal range: < 8.7 µg/L) levels. On transthoracic echocardiography, the left ventricular diastolic and systolic diameters were 5.7 and 4.3 cm, respectively, the ejection fraction calculated with the Simpson method was 43%, and the anterior and anteroseptum segments were hypokinetic. Apical 4-chamber view revealed an apical mobile thrombus (4.1 × 2.1 cm) (Figure 1). Right ventricular function and size were normal. Contrasted computed thorax tomography confirmed a thrombus in the left ventricle (Figure 2). Afterwards, h...

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Section: Discussionmentioning

confidence: 90%

A Young Male Patient With Multiple Thromboembolisms Associated With Factor V Leiden Mutation

et al. 2016

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“…Thrombi in the heart occur predominantly in males and are accompanied with ischemic or nonischemic cardiomyopathy including valvular abnormalities, arrhythmias, thromboembolism, pericarditis, and myocarditis [7]. We have recently reported that the lack of mobility is one of the key factors in most risk assessment models of thromboembolism [8].…”

Section: Discussionmentioning

confidence: 99%

Giant Left Ventricular Thrombus in a Patient with Acute Ischemic Stroke: A Case Report and Minireview

Fan

Silverstein

Khuddus

et al. 2018

Case Reports in Cardiology

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A 56-year-old healthy male with no obvious risk factors or significant past medical history was admitted to the emergency room with acute ischemic stroke. On his transthoracic echocardiography (TTE), an extremely large thrombus was detected at the apex involving the distal anterior wall. The thrombus was predominantly adherent but with a mobile tip. The patient was subsequently managed with dual antiplatelet therapy. In this report, we present an interesting case of an acute ischemic stroke secondary to a giant left ventricular thrombus in a patient with no past significant cardiac or neurologic medical history.

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“…Lee et al proposed that, in comparison to patients with nonpedunculated thrombi, patients with mural pedunculated thrombi are at increased risk for both systemic embolization and recurrent embolism despite anticoagulation therapy. Risk of systemic embolization was higher in patients on anticoagulant therapy compared to surgical therapy (17.7% versus 0%) [15]. Surgical thrombectomy appears to be clinically effective in cases with mobile pedunculated thrombi [16–20].…”

Section: Discussionmentioning

confidence: 99%

Large Left Ventricular Thrombus in a Patient with Systemic and Venous Thromboembolism Secondary to Protein C and S Deficiency

Pahuja

Ainapurapu

Abidov

2017

Case Reports in Cardiology

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58-year-old Hispanic female presented with an altered mental status. A CT scan of the head demonstrated multiple scattered infarcts and a large right temporal lobe infarct. We also diagnosed the patient with right popliteal and femoral vein thrombosis, bilateral pulmonary embolism, and a transient right radial artery occlusion. Her 12-lead EKG showed lateral ST elevation. Emergent coronary angiogram revealed normal coronaries. Echocardiogram demonstrated a large mobile mass attached to the anterolateral free wall with overall normal contractility of the left ventricle. The patient underwent surgical embolectomy to prevent further systemic embolization. Coagulability workup returned positive for protein C and S deficiency. The patient did well after surgery. Following her surgery, we initiated chronic oral anticoagulation. The presentation with intracardiac thrombus in a normal heart should raise a concern of a probable thrombophilia.

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Left Ventricular Thrombus and Subsequent Thromboembolism, Comparison of Anticoagulation, Surgical Removal, and Antiplatelet Agents

Abstract: In this study, the rate of post-treatment thromboembolism was not significantly different among the treatment groups; however, operative treatment tended towards less post-treatment thromboembolism than other treatment groups.

Cited by 94 publications

References 40 publications

A Young Male Patient With Multiple Thromboembolisms Associated With Factor V Leiden Mutation

A Young Male Patient With Multiple Thromboembolisms Associated With Factor V Leiden Mutation

Giant Left Ventricular Thrombus in a Patient with Acute Ischemic Stroke: A Case Report and Minireview

Large Left Ventricular Thrombus in a Patient with Systemic and Venous Thromboembolism Secondary to Protein C and S Deficiency

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