Aims There are limited data about the optimal anti-thrombotic therapy for preventing embolism while minimizing bleeding events in patients with first acute myocardial infarction (AMI) complicated by left ventricular thrombus (LVT). Methods and results Among 2301 consecutive patients with AMI hospitalized between 2001 and 2014, we studied 1850 patients with first AMI who discharged alive to investigate clinical characteristics, incidence of systemic embolism (SE), and association between anticoagulation and embolic or bleeding events. Left ventricular thrombus was diagnosed by echocardiography, left ventriculography, or cardiac magnetic resonance imaging in 92 (5.0%) patients (62 ± 12 years). During a median follow-up period of 5.4 years (interquartile range 2.1-9.1 years), SE occurred in 15 of 92 patients with LVT (16.3%) and 51 of 1758 patients without LVT (2.9%), respectively. Kaplan-Meier analysis showed a significantly higher incidence of SE in the LVT group (log-rank test, P < 0.001). Multivariate analysis showed that LVT was an independent predictor of SE. Among the LVT patients treated with vitamin K antagonists (n = 84), we compared the patients with therapeutic range (TTR) ≥50% (n = 34) and those with TTR <50% (n = 50). Only one embolic event developed in the TTR ≥50% group and nine embolic events developed in the TTR <50% group (2.9% vs. 19%, P = 0.036). There was no difference in major bleeding events (TTR ≥50%; 9% vs. TTR <50%; 8%, P = 0.89). Conclusion Appropriate anticoagulation therapy may decrease the incidence of embolic events without increasing the incidence of bleeding events in patients with first AMI complicated by LV thrombus.

中文翻译：

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首次急性心肌梗死后左心室血栓患者的抗凝联合抗血小板治疗

目的 关于在首次急性心肌梗死 (AMI) 并发左心室血栓 (LVT) 的患者中预防栓塞同时最大限度减少出血事件的最佳抗血栓治疗数据有限。方法和结果 在 2001 年至 2014 年间连续住院的 2301 名 AMI 患者中，我们研究了 1850 名首次出院的 AMI 患者，以调查临床特征、全身性栓塞 (SE) 的发生率以及抗凝与栓塞或出血事件之间的关联。92 名（5.0%）患者（62±12 岁）通过超声心动图、左心室造影或心脏磁共振成像诊断出左心室血栓。在 5.4 年的中位随访期间（四分位距为 2.1-9.1 年），92 名 LVT 患者中有 15 名发生 SE（16. 3%) 和 1758 名无 LVT 患者中的 51 名 (2.9%)。Kaplan-Meier 分析显示 LVT 组的 SE 发生率显着更高（对数秩检验，P < 0.001）。多变量分析表明，LVT 是 SE 的独立预测因子。在接受维生素 K 拮抗剂治疗的 LVT 患者 (n = 84) 中，我们比较了治疗范围 (TTR) ≥ 50% (n = 34) 和 TTR <50% (n = 50) 的患者。TTR ≥50% 组仅发生 1 起栓塞事件，TTR <50% 组发生 9 起栓塞事件（2.9% 与 19%，P = 0.036）。大出血事件没有差异（TTR ≥ 50%；9% vs. TTR <50%；8%，P = 0.89）。结论 急性心肌梗死合并左室血栓患者，适当的抗凝治疗可在不增加出血事件发生率的情况下降低栓塞事件发生率。