# Concurrent Subacute Stent Thrombosis and Left Ventricular Thrombus After STEMI: A Therapeutic Dilemma

## TL;DR

This case study explores the challenges of treating a patient with both stent thrombosis and a heart clot after a heart attack.

## Contribution

The paper presents a rare case highlighting the therapeutic dilemma of managing concurrent stent thrombosis and left ventricular thrombus.

## Key findings

- The patient developed stent thrombosis and a left ventricular thrombus after a heart attack.
- Warfarin was used successfully in combination with antiplatelet therapy.
- There is limited evidence for optimal anticoagulation strategies in this scenario.

## Abstract

Left ventricular thrombus (LVT) is a complication of anterior ST-segment elevation myocardial infarction (STEMI) after delayed reperfusion. The coexistence of LVT and stent thrombosis represents a therapeutic challenge with no defined anticoagulation strategy.

A 74-year-old man with anterior STEMI underwent rescue percutaneous coronary intervention with drug-eluting stents to the left anterior descending artery (LAD) and right coronary artery after 12 hours and was discharged on dual antiplatelet therapy. Three weeks later, he re-presented with severe chest pain and persistent ST-segment elevation. Coronary angiography demonstrated LAD stent thrombosis, treated with repeat angioplasty. Subsequent imaging revealed anterior-apical hypokinesia and a 10 × 6 mm apical LVT. Warfarin was added to dual antiplatelet therapy, achieving anticoagulation before discharge.

This case highlights limited evidence in the setting of coexisting LAD stent thrombosis and LVT after STEMI. Warfarin remains widely used, while data supporting direct oral anticoagulants are scarce.

Individualized antithrombotic strategies balancing ischemic and bleeding risk are essential.