Meltzer R S, Visser C A, Fuster V
Ann Intern Med. 1986 May;104(5):689-98. doi: 10.7326/0003-4819-104-5-689.
Recent progress has been made in diagnosing and tracing the natural history of intracardiac thrombi by echocardiography. Left ventricular thrombi occur and cause emboli in three clinical conditions: acute myocardial infarction, left ventricular aneurysm as a sequel to infarction, and idiopathic dilated cardiomyopathy. Echocardiographic studies have shown that one third of patients with acute anterior myocardial infarction have left ventricular thrombi; only a small percentage of these patients have emboli. Administration of anticoagulants decreases the prevalence of left ventricular thrombi and the frequency of embolization in this group. Thrombi that are protruding and mobile are most likely to embolize. Anticoagulation treatment decreases the prevalence of embolization in idiopathic dilated cardiomyopathy and should be instituted regardless of whether atrial or ventricular thrombi are detected by two-dimensional echocardiography. In patients with chronic left ventricular aneurysm, thrombi occur commonly, but emboli, infrequently. Therefore, data are insufficient to suggest that anticoagulation treatment is indicated, even if left ventricular thrombi are detected by two-dimensional echocardiography.
通过超声心动图诊断和追踪心内血栓的自然病史方面已取得了最新进展。左心室血栓在三种临床情况下发生并导致栓塞：急性心肌梗死、梗死继发的左心室室壁瘤以及特发性扩张型心肌病。超声心动图研究表明，三分之一的急性前壁心肌梗死患者有左心室血栓；这些患者中只有一小部分会发生栓塞。抗凝剂的使用可降低该组患者左心室血栓的发生率和栓塞频率。突出且活动的血栓最有可能发生栓塞。抗凝治疗可降低特发性扩张型心肌病的栓塞发生率，无论二维超声心动图是否检测到心房或心室血栓，均应进行抗凝治疗。在慢性左心室室壁瘤患者中，血栓很常见，但栓塞很少见。因此，即使二维超声心动图检测到左心室血栓，也没有足够的数据表明需要进行抗凝治疗。
