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Updated: Sep 20, 2026

Cardiac Magnetic Resonance for the Evaluation of Suspected Cardiac Thrombus: Conventional and Emerging Techniques
Published on: June 11, 2019
Massive chronic atrial thrombosis
Maria Angela Losi1, Paolo Golino, Sandro Betocchi
1Department of Clinical Medicine and Cardiovascular and Immunological Sciences, Federico II University-School of Medicine, Via Pansini 5, 80131 Naples, Italy. losi@unina.it
Insights
Large left atrial thrombi, previously thought resistant to treatment, can completely resolve with long-term anticoagulant therapy including warfarin and aspirin. Transesophageal echocardiography confirmed thrombus dissolution without clinical embolism.
Area of Science:
- Cardiology
- Vascular Medicine
- Diagnostic Imaging
Background:
- Left atrial thrombosis poses a significant risk of embolic events.
- Large and organized thrombi are often considered resistant to anticoagulant therapy.
Observation:
- A patient presented with a large, old left atrial thrombus detected via transesophageal echocardiography.
- The patient was treated with warfarin and aspirin for two years.
Findings:
- Transesophageal echocardiography revealed complete resolution of the left atrial thrombus.
- No clinical evidence of embolism was observed during or after therapy.
Implications:
- This case suggests that even large, organized thrombi may be susceptible to dissolution with prolonged anticoagulant treatment.
- Transesophageal echocardiography is crucial for monitoring left atrial thrombus resolution and understanding warfarin's efficacy.
- Further research into the lytic potential of anticoagulants like warfarin in complex thrombotic scenarios is warranted.
Abstract:
We report herein a patient in whom a very large and old thrombus in the left atrium was detected by transesophageal echocardiography. The patient started warfarin and aspirin. After 2 years of therapy, transesophageal echocardiography showed the complete resolution of thrombus in the absence of clinical evidence of embolism. This case indicates that large and presumably organized thrombi may be dissolved by an anticoagulant therapy, although the lytic activity of warfarin has never been demonstrated. Transesophageal echocardiography helps in the identification and follow-up of such conditions and contributes to understanding of warfarin action in left atrial thrombosis.
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