cardiovascular disorders
Complications of Acute Coronary Syndromes
Mural Thrombosis
Prior to the modern era of reperfusion therapy, mural thrombosis occurred in about 20% of patients with acute myocardial infarction. Systemic embolism occurs in about 10% of patients with left ventricular thrombosis; risk is highest in the first 10 days but persists at least 3 months. Risk is highest (about 60%) for patients with large anterior infarctions (especially involving the distal septum and apex), a dilated and diffusely hypokinetic left ventricle, or chronic atrial fibrillation. With modern therapy, risk of mural thrombosis is much lower. Anticoagulants are no longer given routinely for primary prevention of mural thrombosis after acute coronary syndrome. Anticoagulant therapy may be considered for patients with STEMI and anterior wall akinesis or dyskinesis, but the patient's risk of bleeding must also be evaluated in light of dual antiplatelet therapy and resultant triple therapy should anticoagulation be chosen. Anticoagulantsarerecommended for patients after ACS with concomitant: Atrial Fibrillation and high thromboembolic risk (eg, Mechanical heart valves Venous thromboembolism Hypercoagulable disorders It also is reasonable to give anticoagulants to patients with STEMI and asymptomatic confirmed LV mural thrombi. 