摘要
目的:探讨急性心肌梗死(AMI)后左心室血栓患者的临床特征,分析易患因素和形成原因,探讨抗栓治疗方法及预后。方法:收集15例经心脏彩色多普勒确诊为AMI后左室血栓患者的临床资料,进行回顾性分析,随访获取患者出院3个月至1年的左室血栓变化及出血、缺血等临床事件。结果:伴高血压病9例(60%),所有患者均累及前壁心肌梗死(100%),其中广泛前壁9例(60%)。9例行冠状动脉造影,其中8例(88.89%)前降支中重度狭窄。所有患者均有室壁瘤形成,左室血栓全部位于左室心尖部。8例华法令、阿司匹林、氯吡格雷3联抗栓治疗患者在3个月时血栓全部消失,5例阿司匹林、氯格雷吡两联抗血小板治疗患者中,3个月时血栓消失3例(60%),血栓体积缩小1例(20%)。结论:高血压、前壁心肌梗死、前降支中重度狭窄是AMI后左室血栓的易患因素;AMI后左心室血栓患者,不超过3个月氯吡格雷、阿司匹林、华法令3联抗栓治疗或许是安全有效的,良好控制INR是减少出血风险的关键。
Objective:To investigate the clinical features, risk factors, antithrombotic therapy and prognosis in patients with left ventricular thrombus (LVT) formation after acute myocardial infarction (AMI). Methods:Retro- spectively analyzed the clinical features in 15 patients with LVT diagnosed by color Doppler. Follow-up of the changes in the size of thrombus, bleeding and other clinical events after patients discharged from 3 months to 1 year. Results:Nine patients (60%) had hypertension, 15 (100%) had anterior myocardial infarction, and 9 (60%) had extensive anterior myocardial infarction. 9 patients were underwent coronary angiography, 8 patients (88.89~/oo) were found with severe stenosis in left anterior descending (LAD) artery, 15 (100%) patients had aneurysm. LVT were all located in the left ventricular apex. In triple antithrombotic therapy (TT, warfarin plus aspirin and clopidogrel) group, 8 (100%) patients' thrombus disappeared after 3 months. In dual antiplatelet therapy (DT, aspirin plus clopidogrel) group, 3 (60%) patients' thrombus disappeared after 3 months, 1 (20%) patient's thrombus decreased. Conclusion: Hypertension, anterior myocardial infarction, severe stenosis in LAD are risk factors of LVT formation after AM1. Triple antithrombotic therapy (no more than 3 months) might be safe and effective for patients with LVT formation after AMI, and the good control of INR is important to help reduc ing the bleeding risk.
出处
《临床心血管病杂志》
CAS
CSCD
北大核心
2013年第10期735-737,共3页
Journal of Clinical Cardiology
基金
国家自然科学基金面上项目资助(No:81270255)
关键词
急性心肌梗死
左室血栓
华法令
阿司匹林
氯吡格雷
acute myocardial infarction
left ventricular thrombus
warfarin
aspirin
clopidogrel