This case demonstrates that severe thromboembolic complications, including LV thrombus and mesenteric embolism, can occur post-MI despite continuous anticoagulation, requiring surgical management.
Warns of embolic risk post-MI despite anticoagulation; leaves open optimal prevention strategies.
A 43-year-old man had transmural anterior wall myocardial infarction complicated by hypotension and anterior-apical aneurysmal formation. Despite continuous anticoagulation with heparin sodium (heparin) and warfarin sodium (coumadin), a large pedunculated left ventricular thrombus was formed. Four hours after uneventful left ventriculography, the patient experienced acute superior mesenteric embolism. An emergency mesenteric embolectomy and then left ventricular aneurysmectomy with clot evacuation were performed to save the bowel and to prevent further embolization.
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Hwang et al. (1985) studied this question.
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