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Left ventricular thrombosis: new perspectives on an old problem

Mauro Massussi1, Andrea Scotti1, Gregory Y H Lip2

  • 1Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua Medical School, Via Giustiniani 2, 35128 Padua, Italy.

European Heart Journal. Cardiovascular Pharmacotherapy
|June 23, 2020
PubMed

Insights

Left ventricular thrombosis (LVT) poses a significant risk for systemic thromboembolism. Current anticoagulation therapies carry bleeding risks, and more research is needed on direct oral anticoagulants for LVT treatment.

Area of Science:

  • Cardiology
  • Hematology
  • Thrombosis Research

Background:

  • Left ventricular thrombosis (LVT) is a critical risk factor for systemic thromboembolism.
  • LVT can complicate both acute and chronic phases of ischemic heart disease post-myocardial infarction and non-ischemic cardiomyopathies.
  • Thrombus formation involves Virchow's triad: blood stasis, prothrombotic state, and tissue injury.

Purpose of the Study:

  • To review the current understanding of left ventricular thrombosis.
  • To discuss the challenges in optimal treatment strategies for LVT.
  • To evaluate the role of anticoagulation in managing LVT and associated risks.

Main Methods:

  • Literature review of pathophysiology and treatment of left ventricular thrombosis.
  • Analysis of current anticoagulation strategies, including heparin and vitamin K antagonists.
  • Examination of emerging data on direct oral anticoagulants for LVT.

Main Results:

  • Advances in imaging have increased LVT detection rates.
  • Conventional anticoagulation reduces embolic risk but increases bleeding complications.
  • Limited data suggests potential safety and efficacy of direct oral anticoagulants for LVT.

Conclusions:

  • Optimal treatment strategies for LVT remain uncertain in clinical practice.
  • Further evidence is required to support the use of direct oral anticoagulants for LVT.
  • Balancing embolic risk reduction with bleeding complications is crucial in LVT management.

Keywords:
Acute myocardial infarctionAnticoagulation therapyLeft ventricular thrombosis

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