Antithrombotic Therapy for Patients With Left Ventricular Mural Thrombus

Area of Science:

• Cardiology
• Cardiovascular Imaging
• Thrombosis Management

Background:

• Contemporary data on left ventricular thrombus (LVT) prognosis and management are limited.
• Understanding LVT evolution and treatment outcomes is crucial for patient care.

Purpose of the Study:

• To quantify the effect of anticoagulation therapy on LVT evolution using sequential imaging.
• To determine the impact of LVT regression on thromboembolism, bleeding, and mortality.

Main Methods:

• Retrospective analysis of 90,065 echocardiogram reports from January 2011 to January 2018.
• Inclusion of 159 patients with confirmed LVT, assessing treatment with anticoagulants and antiplatelets.
• Evaluation of major adverse cardiovascular events (MACE), major bleeding, and all-cause mortality during follow-up.

Main Results:

• LVT regression occurred in 62.3% of patients within a median of 103 days; nonischemic cardiomyopathy and smaller baseline thrombus size were correlates.
• The overall incidence of MACE was 37.1%, mortality 18.9%, stroke 13.3%, and major bleeding 13.2%.
• Total LVT regression was associated with reduced mortality (HR: 0.48) but persistent LVT increased major bleeding risk (HR: 0.34).

Conclusions:

• Left ventricular thrombus (LVT) presence is associated with high risks of MACE and mortality.
• Anticoagulant therapy can achieve LVT regression, which is linked to decreased mortality.
• Optimizing anticoagulation duration and considering factors like LVEF are important for managing LVT patients.