Nokea
The following is most suitable for thromboembolic prophylaxis in a patient with a left ventricular aneurysm following a myocardial infarction three months ago:
Correct Answer: C
Rationale: A left ventricular aneurysm post-MI risks thrombus formation due to stasis, necessitating anticoagulation. IV heparin is acute, not outpatient prophylaxis, impractical here. Subcutaneous enoxaparin prevents thromboembolism short-term (e.g., post-surgery), but its duration suits weeks, not months. Oral warfarin, a vitamin K antagonist, provides long-term anticoagulation (INR 2-3), ideal for chronic prophylaxis against mural thrombi embolizing to systemic circulation, most suitable three months post-MI. Oral aspirin (antiplatelet) or aspirin plus clopidogrel targets arterial clots, less effective for ventricular stasis-related venous thrombi. Warfarin's sustained effect reduces stroke risk, critical in this structural heart defect.