Published online Feb 6, 2024. doi: 10.12998/wjcc.v12.i4.835
Peer-review started: October 23, 2023
First decision: November 22, 2023
Revised: December 4, 2023
Accepted: January 5, 2024
Article in press: January 5, 2024
Published online: February 6, 2024
Processing time: 94 Days and 5.6 Hours
Presently, there is no established standard anti-blood clot therapy for patients facing acute myocardial infarction (AMI) complicated by left ventricular thrombus (LVT). While vitamin K antagonists are the preferred choice for oral blood thinning, determining the best course of blood-thinning medication remains challenging. It is unclear if non-vitamin K antagonist oral blood thinners have different effectiveness in treating LVT. This study significantly contributes to the medical community.
The blood-thinning treatment of a patient with AMI and LVT was analyzed. Triple blood-thinning therapy included daily enteric-coated aspirin tablets at 0.1 g, daily clopidogrel hydrogen sulfate at 75 mg, and dabigatran etexilate at 110 mg twice daily. After 15 d, the patient’s LVT did not decrease but instead increased. Clinical pharmacists comprehensively analyzed the cases from the perspective of the patient’s disease status and drug interaction. The drug regimen was reformulated for the patient, replacing dabigatran etexilate with warfarin, and was administered for six months. The clinical pharmacist provided the patient with professional and standardized pharmaceutical services. The patient’s condition was discharged after meeting the international normalized ratio value (2-3) criteria. The patient fully complied with the follow-up, and the time in the therapeutic range was 78.57%, with no serious adverse effects during pharmaceutical monitoring.
Warfarin proves to be an effective drug for patients with AMI complicated by LVT, and its blood-thinning course lasts for six months.
Core Tip: Current guidelines predominantly offer low-grade recommendations favoring warfarin combined with DAPT for treating left ventricular thrombus (LVT) in acute myocardial infarction, unless contraindicated. However, the ideal duration of this triple therapy remains uncertain. Despite vitamin K antagonists being the preferred oral anticoagulant, it is unclear whether non-vitamin K antagonist oral anticoagulants exhibit distinct effectiveness in LVT treatment. This case report emphasizes that not all patients have sufficient evidence supporting the use of direct-acting oral anticoagulants in LVT management, and the recommended duration of triple therapy is six months.