To anticoagulate or not: implications for the management of patients with acute myocardial infarction complicated by both left ventricular thrombus and pericardial effusion.

We reviewed the clinical and echocardiographic characteristics of seven patients with left ventricular thrombus and pericardial effusion. Each patient had a recent anterior wall myocardial infarction with an apical left ventricular thrombus. Two patients had clinical evidence of pericarditis. On two-dimensional echocardiography, the effusion was judged to be small in five cases and moderate in two. All patients received parenteral heparin therapy; six of the seven patients subsequently received long-term oral anticoagulation therapy. None of the patients had any clinical or two-dimensional echocardiographic evidence of increasing pericardial effusion or tamponade. Documented systemic embolization was seen in only one patient, whose anticoagulant therapy was stopped 2 weeks after myocardial infarction. In five patients, repeat two-dimensional echocardiography was performed from 2 to 4 months after infarction; in four patients, neither pericardial effusion nor left ventricular thrombus was found. In this group of patients, both short- and long-term anticoagulants were safely administered despite pericardial effusion.