Left ventricular mural thrombus.

The identification of mural thrombus in patients with left ventricular aneurysm and mural thrombus probably warrants consideration of long-term anticoagulation. In patients with acute, large, anterior or anteroapical, transmural myocardial infarctions, serial noninvasive examinations are warranted to define a group of patients at high risk for the development of left ventricular aneurysm and/or mural thrombus. Anticoagulants should be considered in patients in whom mural thrombi develop as a complication of their infarction. Patients with congestive cardiomyopathy should be considered for long-term anticoagulation. These recommendations are all tempered by the realization that the use of anticoagulant therapy is not without its own risks. The decision to anticoagulate must be balanced against each individual patient's suitability for such therapy and the individual likelihood of the development of side effects.