Maniwa N, et al. - This research effectuated a scrutiny of the optimal anti-thrombotic therapy for preventing embolism while minimizing bleeding events in patients with first acute myocardial infarction (AMI,) complicated by the left ventricular thrombus (LVT). A decrease could be achieved in the incidence of embolic events without increasing the incidence of bleeding events with the aid of suitable anticoagulation therapy in the study cohort.

Methods

• During this analysis, 1850 patients with first AMI were examined who discharged alive, among 2301 consecutive patients with AMI hospitalized between 2001 and 2014.
• The intent was to gauge the clinical characteristics, incidence of systemic embolism (SE), and association between anticoagulation and embolic or bleeding events.

Results

• Left ventricular thrombus was diagnosed by echocardiography, left ventriculography, or cardiac magnetic resonance imaging in 92 (5.0%) patients (62 ± 12 years).
• The occurrence of SE was noted in 15 of 92 patients with LVT (16.3%) and 51 of 1758 patients without LVT (2.9%), respectively, during a median follow-up period of 5.4 years (interquartile range 2.1-9.1 years).
• Kaplan-Meier analysis illustrated a considerably higher incidence of SE in the LVT group (log-rank test, P < 0.001).
• LVT served as an independent predictor of SE, as determined by the multivariate analysis.
• Among the LVT patients treated with vitamin K antagonists (n = 84), patients with therapeutic range (TTR) ≥50% (n = 34) were compared with those exhibiting TTR <50% (n = 50).
• There was only one embolic event in the TTR ≥50% group and nine embolic events developed in the TTR <50% group (2.9% vs. 19%, P = 0.036).
• No variation was demonstrated in the major bleeding events (TTR ≥50%; 9% vs. TTR <50%; 8%, P = 0.89).