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©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
Individualized anti-thrombotic therapy for acute myocardial infarction complicated with left ventricular thrombus: A case report
Yan Song, Hua Li, Xia Zhang, Lei Wang, Hong-Yan Xu, Zhi-Chao Lu, Xiao-Gang Wang, Bo Liu
Yan Song, Xia Zhang, Hong-Yan Xu, Zhi-Chao Lu, Department of Clinical Pharmacy, Zibo Municipal Hospital, Zibo 255400, Shandong Province, China
Hua Li, Department of Cardiology, Zibo Municipal Hospital, Zibo 255400, Shandong Province, China
Lei Wang, Department of Pharmacy, Zibo Municipal Hospital, Zibo 255400, Shandong Province, China
Xiao-Gang Wang, Department of Imaging, Zibo Municipal Hospital, Zibo 255400, Shandong Province, China
Bo Liu, Department of Pulmonary and Critical Care Medicine, Department of Clinical Microbiology, Zibo City Key Laboratory of Respiratory Infection and Clinical Microbiology, Zibo City Engineering Technology Research Center of Etiology Molecular Diagnosis, Zibo Municipal Hospital, Zibo 255400, Shandong Province, China
Author contributions: Song Y and Li H contributed to conceptualization, methodology, data curation and analysis, writing (original draft), and visualization; Zhang X and Wang L contributed to acquisition of data; Xu HY, Lu ZC, Wang XG, and Liu B contributed to writing (review and editing); Wang XG and Liu B involved in the supervision and supervision; and all authors have read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Bo Liu, PhD, Doctor, Department of Pulmonary and Critical Care Medicine, Department of Clinical Microbiology, Zibo City Key Laboratory of Respiratory Infection and Clinical Microbiology, Zibo City Engineering Technology Research Center of Etiology Molecular Diagnosis, Zibo Municipal Hospital, No. 139 Luan Road, Linzi District, Zibo 255400, Shandong Province, China. lwmx@foxmail.com
Received: October 23, 2023
Peer-review started: October 23, 2023
First decision: November 22, 2023
Revised: December 4, 2023
Accepted: January 5, 2024
Article in press: January 5, 2024
Published online: February 6, 2024
BACKGROUND
Presently, there is no established standard anti-blood clot therapy for patients facing acute myocardial infarction (AMI) complicated by left ventricular thrombus (LVT). While vitamin K antagonists are the preferred choice for oral blood thinning, determining the best course of blood-thinning medication remains challenging. It is unclear if non-vitamin K antagonist oral blood thinners have different effectiveness in treating LVT. This study significantly contributes to the medical community.
CASE SUMMARY
The blood-thinning treatment of a patient with AMI and LVT was analyzed. Triple blood-thinning therapy included daily enteric-coated aspirin tablets at 0.1 g, daily clopidogrel hydrogen sulfate at 75 mg, and dabigatran etexilate at 110 mg twice daily. After 15 d, the patient’s LVT did not decrease but instead increased. Clinical pharmacists comprehensively analyzed the cases from the perspective of the patient’s disease status and drug interaction. The drug regimen was reformulated for the patient, replacing dabigatran etexilate with warfarin, and was administered for six months. The clinical pharmacist provided the patient with professional and standardized pharmaceutical services. The patient’s condition was discharged after meeting the international normalized ratio value (2-3) criteria. The patient fully complied with the follow-up, and the time in the therapeutic range was 78.57%, with no serious adverse effects during pharmaceutical monitoring.
CONCLUSION
Warfarin proves to be an effective drug for patients with AMI complicated by LVT, and its blood-thinning course lasts for six months.
Core Tip: Current guidelines predominantly offer low-grade recommendations favoring warfarin combined with DAPT for treating left ventricular thrombus (LVT) in acute myocardial infarction, unless contraindicated. However, the ideal duration of this triple therapy remains uncertain. Despite vitamin K antagonists being the preferred oral anticoagulant, it is unclear whether non-vitamin K antagonist oral anticoagulants exhibit distinct effectiveness in LVT treatment. This case report emphasizes that not all patients have sufficient evidence supporting the use of direct-acting oral anticoagulants in LVT management, and the recommended duration of triple therapy is six months.
