Embolic stroke remains an important cause of morbidity after myocardial infarction, even in the thrombolytic era. Left ventricular mural thrombi and subsequent embolization can be prevented by early systemic anticoagulation of patients with large anterior myocardial infarcts. Echocardiography has been instrumental in refining our understanding of the pathophysiology of this disorder and is a useful clinical tool in the identification of patients who would benefit from continued anticoagulation.
VaitkusPTBerlinJASchwartzJSBarnathanES: Stroke complicating acute myocardial infarction: A meta-analysis of risk modification by anticoagulation and thrombolytic therapy. Arch Intern Med1992, 152: 2020–2024. A meta-analysis of all published controlled clinical trials of anticoagulation and thrombolysis. In addition to quantifying the impact of these therapeutic modalities on the risk of stroke after myocardial infarction, the paper includes a thorough discussion of the topic and an extensive bibliography.
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AsingerRWMikellFLElspergerJHodgesM: Incidence of left ventricular thrombosis after acute transmural myocardial infarction. N Engl J Med1981, 305: 297–302. A landmark study that demonstrated the feasibility of identifying left ventricular thrombi and identified the major risk factors for mural thrombus formation.
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VaitkusFTBarnathanES: Embolic potential, prevention and management of mural thrombus complicating anterior myocardial infarction: A meta-analysis. J Am Coll Cardiol1993, 22: 1004–1009. This is a meta-analysis of the many small studies in this field which has adequate statistical power to address the questions of the risk posed by mural thrombi and the therapeutic modalities that are useful in reducing mural thrombus formation and embolization. A complete bibliography of this topic is provided.
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LamasGAVaughanDEPfefferMA: Significance of a lateral Q wave following first anterior wall acute myocardial infarction. Am J Cardiol1990, 65: 674–675. An interesting observation on an electrocardiographic predictor of mural thrombus formation.
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SagieAStrasbergBImbarSRechaviaESclarovskyS: Value of the electrocardiogram for prediction of left ventricular mural thrombus in anterior wall acute myocardial infarction. Am J Cardiol1991, 68: 957–959.
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JohannessenKANordrehaugJEvon der LippeGVollsetSE: Risk factors for embolisation in patients with left ventricular thrombi and acute myocardial infarction. Br Heart J1988, 60: 104–110. This study examined echocardiographic characteristics associated with embolic risk.
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LloretRLCortadaXBradfordJMetzMNKinneyEL: Classification of left ventricular thrombi by their history of systemic embolization using pattern recognition of two-dimensional echocardiography. Am Heart J1985, 110: 761–765.
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StrattonJRRitchieJL: 111In platelet imaging of left ventricular thrombi: Predictive value for systemic emboli. Circulation1990, 81: 1181–1189. Examination of the utility of indium-111-labeled platelet imaging in evaluating the risk of embolism.
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O'ConnorCMCaliffRMMasseyRWMarkDBKereiakesDJCandelaRJ: Stroke and acute myocardial infarction in the thrombolytic era: Clinical correlates and long-term prognosis. J Am Coll Cardiol1990, 16: 533–540. Systematic examination of the quantitative and qualitative differences between embolic and hemorrhagic strokes complicating myocardial infarction.
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GunnarRMBourdillonPDDixonDWFusterVKarpRBKennedyJW: ACC/AHA guidelines for the early management of patients with acute myocardial infarction. A report of the American College of Cardiology/American Heart Association Task Force on Assessment of Diagnostic and Therapeutic Cardiovascular Procedures (Subcommittee to develop guidelines for the early management of patients with acute myocardial infarction). J Am Coll Cardiol1990, 16: 249–292. A comprehensive set of recommendations from an authoritative body on all aspects of managing patients with acute myocardial infarction, including considerations for anticoagulation.
