JACC. Case reports · 2026
Staged Antithrombotic Reinitiation After STEMI Complicated by LV Thrombus and Intracerebral Hemorrhage.
Клинический случайСтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Mokrytzki Slake, Chua Anne Yan Ting, Thompson Alison, Mesarina Miguel, Setaro John F
Аннотация
BACKGROUND: Left ventricular thrombus after anterior ST-segment elevation myocardial infarction requires anticoagulation, and recent stenting requires dual antiplatelet therapy, but no guideline addresses antithrombotic sequencing when intracerebral hemorrhage complicates both.
CASE SUMMARY: A 63-year-old woman developed an apical left ventricular thrombus after left anterior descending artery percutaneous coronary intervention for late anterior ST-segment elevation myocardial infarction, then a left temporal intracerebral hemorrhage on day 2 while receiving aspirin, ticagrelor, and heparin. Declining ejection fraction and enlarging thrombi prompted staged reinitiation: cangrelor, clopidogrel, unfractionated heparin, then apixaban after serial neuroimaging confirmed stability.
WHY BEYOND THE GUIDELINES: No guideline addresses the timing, sequence, or agent selection when these 3 indications converge.
DISCUSSION: Staged reinitiation with short-acting and reversible agents may allow antithrombotic escalation guided by serial neuroimaging stability.
TAKE-HOME MESSAGE: When competing thrombotic and hemorrhagic risks fall outside guideline pathways, antithrombotic therapy can be reintroduced in reassessable steps, starting with short-acting agents, guided by serial neuroimaging.
CASE SUMMARY: A 63-year-old woman developed an apical left ventricular thrombus after left anterior descending artery percutaneous coronary intervention for late anterior ST-segment elevation myocardial infarction, then a left temporal intracerebral hemorrhage on day 2 while receiving aspirin, ticagrelor, and heparin. Declining ejection fraction and enlarging thrombi prompted staged reinitiation: cangrelor, clopidogrel, unfractionated heparin, then apixaban after serial neuroimaging confirmed stability.
WHY BEYOND THE GUIDELINES: No guideline addresses the timing, sequence, or agent selection when these 3 indications converge.
DISCUSSION: Staged reinitiation with short-acting and reversible agents may allow antithrombotic escalation guided by serial neuroimaging stability.
TAKE-HOME MESSAGE: When competing thrombotic and hemorrhagic risks fall outside guideline pathways, antithrombotic therapy can be reintroduced in reassessable steps, starting with short-acting agents, guided by serial neuroimaging.