急性心肌梗死后左心室血栓的临床特征及抗栓治疗

Analysis of clinical features and antithrombotic treatment in patients with left ventricular thrombus formation after acute myocardial infarction

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.