Coronary Artery Disease - STEMI Case #3 - Question #3 Answer

An echocardiogram showed severe anterior, anteroapical and apical hypokinesis. The patient does clinically well and is ready for discharge.

Which of the following statements is false regarding using coumadin to prevent thromboembolism in this situation?

A. Coumadin is recommended after all anterior wall myocardial infarctions with residual wall motion abnormalities to prevent thromboembolism

B. Coumadin is recommended after all anterior wall myocardial infarctions in which a left ventricular apical thrombus is visualized

C. Coumadin is recommended after an anterior wall myocardial infarction when a thromboembolic event has occurred, even if thrombus is not visualized

D. All of the above are true

 

After myocardial infarctions (especially anteriorly), the myocardial stunning that occurs can result in blood pooling toward the akinetic segment (frequently the cardiac apex), resulting in thrombus formation. Embolization of this thrombus can cause a stroke. There is no good data regarding prevention of left ventricular thrombi; however the American College of Cardiology/American Heart Association guidelines give a class I, level of evidence B recommendation to warfarin therapy for 3 months when there is a cardiac source of embolus suspected after a MI.