Key result
A 76-year-old woman developed a floating thrombus in a left ventricular aneurysm and subsequent ischemic stroke following COVID-19 infection, despite receiving dual antithrombotic therapy.
Why the study?
There is no consensus on the optimal anticoagulant regimen in patients with COVID-19 and a complicated cardiovascular history.
Case Report (n=1)
Highlights the potential for left ventricular thrombus formation and systemic embolism in patients with a history of myocardial infarction and LV aneurysm who contract COVID-19, even while on direct oral anticoagulants and antiplatelet therapy.
Answers are grounded in this paper and cite their sources.
LV thrombus can precipitate vertebrobasilar stroke in post-MI aneurysm patients; leaves open optimal anticoagulation strategies.
Left ventricular (LV) thrombosis is a common complication of heart failure with reduced LV ejection fraction and can be a source of systemic embolism. The material presents the case of a 76-year-old woman with a history of myocardial infarction, LV aneurysm, coronary bypass surgery, who was admitted to the hospital with ischemic vertebrobasilar stroke. One month prior to present hospitalization, the patient was admitted to the hospital with transient complete atrioventricular block, underwent coronary artery stenting for stable angina pectoris with a drug-eluting stent, and was subsequently diagnosed with coronavirus disease 2019 (COVID-19), which required further inpatient treatment. Despite dual antithrombotic therapy (antiplatelet+anticoagulant) taken after discharge from the hospital, the patient was diagnosed with a floating thrombus in the apical LV aneurysm. Recurrent conduction disorders (transient atrioventricular block) required temporary pacing until the thrombus elements floated, after which a dual-chamber pacemaker was implanted. The main feature of this case is the formation of a floating thrombus in the LV aneurysm 11 years after myocardial infarction against the background of COVID-19 and anticoagulant therapy with direct oral anticoagulants. At the moment, there is still no unique opinion on the choice of anticoagulant therapy in patients with COVID-19 and a complicated cardiovascular history. In such cases, the anticoagulant regimen should be determined by a multidisciplinary team, taking into account the risks of thrombosis and bleeding.
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Pavlenko et al. (2023) conducted a case report in Ischemic stroke, floating thrombosis of left ventricular aneurysm, COVID-19 (n=1). COVID-19 infection and dual antithrombotic therapy was evaluated on Formation of floating thrombus and ischemic stroke. A 76-year-old woman developed a floating thrombus in a left ventricular aneurysm and subsequent ischemic stroke following COVID-19 infection, despite receiving dual antithrombotic therapy.
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