Case report: Oral anticoagulant combined with percutaneous coronary intervention for peripheral embolization of left ventricular thrombus caused by myocardial infarction in a patient with diabetes mellitus.
Case report: Oral anticoagulant combined with percutaneous coronary intervention for peripheral embolization of left ventricular thrombus caused by myocardial infarction in a patient with diabetes mellitus.
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DOI：
10.3389/fcvm.2022.1019945
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发表时间：
2022
影响因子：
3.6
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中科院分区：
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左室血栓（LVT）是糖尿病患者心肌梗死（MI）的一种公认的并发症。LVT引起的栓塞并发症是一个关键的临床问题，并与恶化的长期生存有关。45岁男性，因持续左腹痛1周及左腿疲劳入院急诊。腹痛的原因是心源性血栓形成导致肾动脉、脾动脉、肠系膜上动脉栓塞，进而导致脾梗死、肾梗死。心肌梗死发生的时间尚不清楚，因为患者没有典型的危重性胸痛，这可能与糖尿病并发症有关，如糖尿病周围神经病变。糖尿病在心肌梗死和LVT形成中起关键作用。由于冠状动脉造影提示三支血管病变，行经皮腔内冠状动脉成形术（PTCA），并在左冠状动脉前降支（LAD）置入2个药物洗脱支架。由于缺乏随机临床对照试验，LVT的治疗和相关的栓塞一直是积极的争论。根据目前的指南，该患者在服用阿司匹林（100mg /天）和氯吡格雷（75mg /天）的基础上，使用低分子肝素和华法林（口服抗凝剂）治疗3个月。没有发现严重的出血并发症，随访检查显示左心室没有血栓或进一步的周围血栓事件。心肌梗死引起的LVT外周栓塞导致多器官栓塞仍然是罕见的。糖尿病在心肌梗死和LVT形成中起关键作用。成功的梗死相关冠状动脉血运重建和抗凝治疗对于减少心肌损伤和预防LVT至关重要。本病例将帮助临床医生识别和管理LVT患者的糖尿病和相关的外周动脉血栓形成事件与抗凝。
Left ventricular thrombus (LVT) is a well-recognized complication of myocardial infarction (MI) in patients with diabetes. An embolic complication caused by LVT is a key clinical problem and is associated with worsened long-term survival. A 45-year-old man with persistent left abdominal pain for 1 week and left leg fatigue was admitted to the emergency department. The cause of abdominal pain was embolism of the renal artery, the splenic artery, and the superior mesenteric artery caused by cardiogenic thrombosis, which further led to splenic infarction and renal infarction. It was unclear when MI occurred because the patient had no typical critical chest pain, which may have been related to diabetic complications, such as diabetic peripheral neuropathy. Diabetes plays a pivotal role in MI and LVT formation. Because coronary angiography suggested triple vessel disease, percutaneous transluminal coronary angioplasty (PTCA) was conducted, and two drug-eluting stents were placed in the left anterior descending coronary artery (LAD). Due to a lack of randomized clinical control trials, the therapy of LVT and associated embolization has been actively debated. According to the present guidelines, this patient was treated with low-molecular-weight heparin and warfarin (oral anticoagulants) for 3 months in addition to aspirin (100 mg/day) and clopidogrel (75 mg/day) for 1 year. No serious bleeding complications were noted, and a follow-up examination showed no thrombus in the left ventricle or further peripheral thrombotic events. Peripheral embolization of LVT caused by MI leading to multiple organ embolization remains a rare occurrence. Diabetes plays a pivotal role in MI and LVT formation. Successful revascularization of the infarct-related coronary artery and anticoagulation therapy is important to minimize myocardial damage and prevent LVT. The present case will help clinicians recognize and manage LVT in patients with diabetes and related peripheral arterial thrombotic events with anticoagulation.