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An evidence-based evaluation of left ventricular thrombus treatment, outcomes, and resolution: a systematic review,

Chun Shing Kwok1,2, Sadie Bennett2, Josip A Borovac3

  • 1Department of Post Qualifying Healthcare Practice, Birmingham City University, Birmingham.

Coronary Artery Disease
|March 23, 2023
PubMed

Insights

Direct oral anticoagulants (DOACs) reduce mortality and bleeding in patients with left ventricular thrombus (LVT) compared to warfarin. While DOACs show promise, individualized treatment and follow-up imaging are crucial for optimal LVT management.

Area of Science:

  • Cardiology
  • Hematology
  • Pharmacology

Background:

  • Left ventricular thrombus (LVT) is a significant complication of acute myocardial infarction, increasing stroke risk.
  • Existing literature lacks a comprehensive systematic review on LVT patient outcomes.
  • This review addresses treatment efficacy, adverse events, and thrombus resolution in LVT patients.

Approach:

  • A systematic review and meta-analysis were conducted, pooling data from 39 studies.
  • Included 5475 patients with LVT and 356,589 patients without LVT.
  • Outcomes were evaluated based on treatment type and LVT presence.

Key Points:

  • Direct oral anticoagulants (DOACs) demonstrated reduced mortality (RR 0.66) and bleeding (RR 0.64) versus warfarin.
  • DOACs showed a nonsignificant reduction in stroke/embolic events (RR 0.95) compared to warfarin.
  • Overall, 6.4% experienced stroke/embolic events, 3.7% bleeding, and 7.9% mortality within 12 months.
  • Approximately 80% of LVT resolved by 6 months, with Apixaban showing the highest resolution rate (93.3%).

Conclusions:

  • DOACs represent a preferred management strategy over warfarin for LVT.
  • Individualized antithrombotic therapy is essential due to variable resolution rates.
  • Follow-up imaging post-anticoagulant discontinuation is recommended to confirm LVT resolution.

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