{
  "abstract": "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.",
  "abstract_shown": true,
  "affiliations": [
    "Greenwich Hospital, Greenwich, Connecticut, USA; Yale School of Medicine, New Haven, Connecticut, USA"
  ],
  "article_type": "case report",
  "arxiv": null,
  "author_total": 5,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Slake Mokrytzki, MBBS"
    },
    {
      "affs": [
        0
      ],
      "name": "Anne Yan Ting Chua, MBBS"
    },
    {
      "affs": [
        0
      ],
      "name": "Alison Thompson, MD"
    },
    {
      "affs": [
        0
      ],
      "name": "Miguel Mesarina, DO"
    },
    {
      "affs": [
        0
      ],
      "name": "John F. Setaro, MD"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/4egrt8tnsr06a.bib",
  "cited_by": 1,
  "doi": "10.1016/j.jaccas.2026.109886",
  "fulltext_url": "http://www.sciencedirect.com/science/article/pii/S2666084926030470",
  "id": "4egrt8tnsr06a",
  "issns": [
    "2666-0849"
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  "landing_url": "https://doi.org/10.1016/j.jaccas.2026.109886",
  "language": "en",
  "licence": "CC-BY-NC-ND-4.0",
  "licence_label": "CC BY-NC-ND 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Beyond the Guidelines"
    ],
    [
      "heading",
      "Coronary, Peripheral, and Structural Interventions"
    ],
    [
      "lcc",
      "RC666-701"
    ],
    [
      "openalex",
      "2705|Antiplatelet Therapy and Cardiovascular Diseases"
    ]
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  "openalex": "W7203821691",
  "pdf_url": null,
  "pmcid": "PMC13698927",
  "pmid": "42622585",
  "published": "2026-08-20",
  "publisher": "Elsevier",
  "ris": "https://research.draconitic.com/paper/4egrt8tnsr06a.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:17:17Z",
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  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2705|Antiplatelet Therapy and Cardiovascular Diseases",
      "subfield": "cardiovascular"
    }
  ],
  "title": "Staged Antithrombotic Reinitiation After STEMI Complicated by LV Thrombus and Intracerebral Hemorrhage",
  "title_text": "Staged Antithrombotic Reinitiation After STEMI Complicated by LV Thrombus and Intracerebral Hemorrhage",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T13:43:15Z",
  "url": "https://research.draconitic.com/paper/4egrt8tnsr06a",
  "venue": "JACC: Case Reports",
  "versions": []
}