Hit Two Birds With One Stone Via Thrombolytic Treatment

Year 2019, Volume: 3 Issue: 2, 85 - 89, 30.06.2019

Flora Özkalaycı Aykun Hakgör Süleyman Karakoyun Ali Karagöz İbrahim Halil Tanboğa

https://doi.org/10.33716/bmedj.501588

Abstract

Early data showed that in the setting of acute myocardial infarction
(AMI), left ventricular thrombus (LVT) was present in most frequently in acute
apical or anterior AMI. There are several studies on the frequency of LVT
formation in patients treated with precurtain coronary intervention (PCI).
Solheim et al. reported LVT incidence of 15% in the first 3 months in AMI
patients who were treated with primary PCI. In a meta-analysis it was shown
that LVT is an important problem especially among patients with anterior AMI
and management strategy is a point of interest. The incidence of LVT is in a
decline recently. According to the current guidelines, immediate
revascularisation of infarct related artery, use of sufficient anticoagulant
therapy and agents that improve remodelling of the left ventricle was associated
with decrease in incidence of LVT. Although the use of ACE-inhibitors had a
favourable effect on left ventricle remodelling, there were no differences in
LVT formation between those patients on ACE-inhibitor therapy and those who
were not. LVT formation is associated with the infarct region, more frequent in
anterior AMI, extent of infarct area and presence of aneurysm.

In this case report we present a patient applied to the hospital with
neurologic symptoms and diagnosed with acute ischemic stroke possibly due to
left ventricle thrombus, possibly developed after the anterior MI 20 days ago.
By thrombolytic therapy cardiac thrombus was dissolved and after 7 days the
patient had complete neurologic recovery.

Keywords

Left ventricle thrombus, apical aneurism, complications of myocardial infarction

Trombolitik Tedavi ile Bir Taşla İki Kuş

Abstract

Son çalışmalar, sol ventrikül trombüsü (LVT) en sık akut anterior
miyokard infarktüsü (AMI) sonrasında görülmektedir. AMI sonrası perkütan
koroner girişim (PCI) uygulanan hastalarda LVT oluşumu sıklığına dair çeşitli
çalışmalar mevcuttur Solheim ve ark. anterior AMI sonrası ilk 3 ay içinde LVT oluşum
insidansını %15 olarak bildirmişlerdir. Yine bir meta-analizde LVT'nin
özellikle anterior AMI'de görülen önemli bir komplikasyon olup, tedavi yönetimi
konusu ilgi çekmektedir. Son zamanlarda klavuzların tavsiyesi doğrultusunda AMI
ile gelen vakaların hızlı revaskülarizasyonu sonrasında sol ventrikül yeniden
şekillenmesine etkili ilaçların, antikoagulan ve antiagregan kulanımının
yaygınlaşması ile LVT görülme sıklığı giderek azalmakla birlikte, ACE
kullanmakta olan grup ile kullanmayan grup arasında LVT oluşumu açısından fark
bulunamamıştır. LVT oluşumu infarkt bölgesi, yaygınlığı ve anevrizma olup
olmadığı ile ilişkili bulunmuştur. Bu olgu bildirisinde hastaneye nörolojik
şikayetlerle başvuran sonrasında akut iskemik strok tanısı almış, 20 gün
öncesinde akut anterior AMI öyküsü olan ekokardiyografisinde sol ventrikül
trombüsü saptanmış bir vaka anlatılmaktadır. Hastaya trombolitik tedavi
uygulanmış olup tedaviden 7 gün sonrasında nörolojik fonksiyonlarının normale
dönmesinin yanısıra LVT tamamen gerilemiştir.

Keywords

sol ventrikül trombüs, apikal anevrizma, myokard infarktüsü komplikasyonları

References

• References1-Asinger RW, Mikell FL, Elsperger J, et al. Incidence of left-ventricular thrombosis after acute transmural myocardial infarction. Serial evaluation by two-dimensional echocardiography. N Engl J Med 1981; 305: 297–302.
• 2-Visser CA, Kan G, Lie KI, et al. Left ventricular thrombus following acute myocardial infarction: a prospective serial echocardiographic study of 96 patients. Eur Heart J 1983;4:333–7.
• 3- Solheim S, Seljeflot I, Lunde K, et al. Frequency of left ventricular thrombus in patients with anterior wall acute myocardial infarction treated with percutaneous coronary intervention and dual antiplatelet therapy. Am J Cardiol 2010; 106: 1197–200.4-Robinson AA, Jain A, Gentry M, Mc Namara RL. Left ventricular trombi after STEMİ in the primary PCI era:A systematic review and meta-analysis.Int J Cardiol 2016; 221: 554-9.
• 5- Chiarella F, Santoro E, Domenicucci S, et al. Predischarge two-dimensional echocardiographic evaluation of left ventricular thrombosis after acute myocardial infarction in the GISSI-3 study. Am J Cardiol 1998; 81: 822–7.
• 6- Weinsaft JW, Kim HW, Crowley AL, et al. LV thrombus detection by routine echocardiography: insights into performance characteristics using delayed enhancement CMR. J Am Coll Cardiol img 2011; 4: 702–12.
• 7- Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K et al., 2018 guidelines for the early management of patients with acute ischemic stroke: A Guidelie for Healthcare Professionlas From the American Heart Association/American Stroke Association. Stroke 2018; 49: 46-99.
• 8-Dewilde WJ, Oirbans T, Verheugt FW, Kelder JC, De Smet BJ, Herrman JP et al., Use of clopidogrel with or without aspirin in patients taking oral anticoagulant therapy and undergoing percutaneous coronary intervention: an open-label, randomised, controlled trial. Lancet 2013; 381: 1107-15.