急性心肌梗死合并左心室附壁血栓患者经皮冠状动脉介入术后的抗栓治疗

Anticoagulation therapy for post-PCI patients with left ventricular mural thrombus after acute myocardial infarction

目的分析急性心肌梗死（AMI）并发左心室附壁血栓（LvT）行经皮冠脉介入治疗（PCI）患者的临床特征及抗栓治疗。方法收集煤炭总医院2005年8月至2012年2月确诊为急性心肌梗死并发左室附壁血栓并行PCI治疗的12例患者的临床资料，对其进行回顾性分析。结果广泛前壁心肌梗死、前壁心肌梗死9例（75％），左室射血分数低于40％共7例（58％），冠脉造影检查三支及以上血管病变7例（58％）。6例给予华法林、阿司匹林、氯吡格雷三联抗栓，2例给予西洛他唑、阿司匹林及氯吡格雷三联抗血小板治疗，随访期间血栓均消失。4例双联抗血小板治疗者l例发生脑梗死后加用华法林，3例患者血栓消失，1例血栓机化。12例患者均未出现严重出血现象。结论急性心肌梗死并发左心室附壁血栓并接受PCI治疗患者，充分衡量获益及出血风险，按照个体化原则给予抗栓治疗安全有效。

Objective To analyze the clinical characteristics and anticoagulation therapy of post-PCI pa- tients with left ventricular mural thrombus （LVT） after acute myocardial infarction （AMI）. Methods The clinical data of 12 post-PCI patients with LVT after AMI enrolled from August 2005 to February 2012 were retrospectively analyzed. Results The anterior AM1 was 9（75%）. Patients with LVEF〈40% was 7（58%）. Coronary angiography showed 7 patients（58%） with 3 branches coronary lesions. 6 patients were given warfarin, aspirin and clopidogrel, 2 were given cilostazol, aspirin and clopidogrel, the LVT was disappeared during follow-up period. 4 patients were given aspirin and clopidogrel, in which 1 has cerebral infarction and then added warfarin, LVT disappeared in 3 cases and 1 thrombus was found to be organization. No serious bleeding complications happened in 12 patients. Conclusion For post-PCI patients with LVT after AMI, after assessing the beneficiation and risk of bleeding, the anticoagulation therapy with individual principle is safe and favorable.