1 / 11

“ Wave a red flag” For Anticoagulation, When You Encounter Mobile LV Clot !

“ Wave a red flag” For Anticoagulation, When You Encounter Mobile LV Clot !. Dr.S.Venkatesan , Department of cardiology , Madras medical college , Chennai. LV clot in STEMI. The natural history of LV clot is variable. S pontaneous dissolution often occur .

stacey
Download Presentation

“ Wave a red flag” For Anticoagulation, When You Encounter Mobile LV Clot !

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. “ Wave a red flag” ForAnticoagulation, When You Encounter Mobile LV Clot ! Dr.S.Venkatesan , Department of cardiology , Madras medical college , Chennai.

  2. LV clot in STEMI The natural history of LV clot is variable. Spontaneous dissolution often occur . Stroke and peripheral embolism, are other natural events by which left ventricle get rid of the clot. Oral anticoagulants are commonly administered in this situation

  3. Why do we prescribe warfarinin LV clot ? Because it is a standard practice ! We hope . . . it will prevent the progression of clot and prevent embolism . But . . . Whether warfarin dissolves , regress or dislodge the thrombus is not known .

  4. The morphology and the behaviour of LV clot Once the clot begins to form over the LV further course is dictated by local hemodynamic and rheological factors Drugs administered in the peri infarct phase also play an important role. LV clot could be linear , layered , projectile or pedunculated.

  5. Mobile LV clot & CVA 8 patients, with LV clot Age range 22-58 . All had anterior MI. The mean EF was 38%(28-43%) The mean size of LV clot was 1.4cm (7 - 14mm) 3 had highly mobile clot. 5 had relatively fixed clot. All were put on titrated warfarin.

  6. Patient follow up . . .4 Weeks Two patients who had large LV clot with a stalk got dislodged after starting anticoagulation. The CVA occurred on 12th and 14th day after starting warfarin The 5 patients who showed relatively stable clots are attending to our cardiology OPD without any events. One patient who had a mobile clot , which got organized at 4 weeks , incidentally this patient had discontinued anticoagulants

  7. Warfarin is known to dissolve clots inside LA, LV . And hence it can be categorised as indirect thrombolytic agents. Pedicle at risk Due to it’s relative thinness and more surface area As is exposed to a high plasma anticoagulation activity.

  8. Circulating Anticoagulants + Warfarin Un safe clot and vulnerable pedicle

  9. How to facilitate safe clot formation?

  10. Conclusion Oral anticoagulation has a potential to destabilise and dislodge a mobile LV clot in the early days following STEMI . Existing anticoagulation protocol recommends, oral anticoagulation for all patients who have LV clot. This need to be redefined. If surgery is not an option , temporary withdrawal of anticoagulation may be indicated in selected patients with LV clot, to facilitate organization of clot.

  11. Can we prove with evidence warfarin dislodges moblie LV clots ? Probably not but we can’t disprove that either ! “scene of crime” hypothesis would strongly point out the culprit be warfarin in our patients You can’t have a RCT in this issue right now ! But we argue you to specifically observe this group of patients in the future.

More Related