What's the optimal duration of anticoagulation in patients with left ventricular thrombus?

Expert Rev Cardiovasc Ther. 2023 Jul-Dec;21(12):947-961. doi: 10.1080/14779072.2023.2270906. Epub 2023 Dec 13.

Abstract

Introduction: Left ventricular thrombus (LVT) occurs in acute myocardial infarction and in ischemic and non-ischemic cardiomyopathies. LVT may result in embolic stroke. Currently, the duration of anticoagulation for LVT is unclear. This is an important clinical question as prolonged anticoagulation is associated with increased bleeding risks, while premature discontinuation may result in embolic complications.

Areas covered: There are no randomized trial data regarding anticoagulation duration for LVT. Guidelines and expert consensus recommend anticoagulation for 3-6 months with cessation of anticoagulation if interval imaging demonstrates thrombus resolution. Cardiac magnetic resonance imaging (CMR) is more sensitive and specific compared to echocardiography for LVT detection, and may be appropriate for high-risk patients. Prolonged anticoagulation may be considered in unresolved protuberant or mobile LVT, and in patients with resolved LVT but persistent depressed left ventricular ejection fraction and/or myocardial akinesia or dyskinesia.

Expert opinion: CMR will likely be increasingly used for LVT surveillance to guide anticoagulation duration. Further research is needed to determine which patients with persistent LVT on CMR benefit from prolonged anticoagulation.

Keywords: Cardiac imaging; cardiac magnetic resonance imaging; cardiomyopathy; echocardiography; left ventricular thrombus; thrombosis.

Publication types

  • Review

MeSH terms

  • Anticoagulants / adverse effects
  • Humans
  • Myocardial Infarction* / complications
  • Stroke Volume
  • Thrombosis* / diagnostic imaging
  • Thrombosis* / drug therapy
  • Thrombosis* / etiology
  • Ventricular Function, Left

Substances

  • Anticoagulants