[Anticoagulant therapy in left ventricular non-compaction: when, how and why]

Area of Science:

• Cardiology
• Hematology

Background:

• Left ventricular non compaction (LVNC) is a spectrum of myocardial diseases associated with significant risks of heart failure, arrhythmias, and thromboembolic events.
• Thromboembolism is a notable complication in LVNC patients, necessitating careful risk assessment and management strategies.
• Current guidelines recommend anticoagulation for LVNC with atrial fibrillation or left ventricular thrombosis, but its use in sinus rhythm with systolic dysfunction or isolated deep intertrabecular recesses remains debated.

Approach:

• This article systematically reviews current evidence on thromboembolic risk stratification in LVNC.
• It examines the rationale and evidence supporting the initiation of anticoagulant therapy in various LVNC clinical scenarios.
• A novel flowchart is proposed to guide clinical decision-making regarding anticoagulation in LVNC.

Key Points:

• LVNC patients face a higher prevalence of thromboembolic events compared to the general population.
• Anticoagulant therapy is established for LVNC with atrial fibrillation or left ventricular thrombosis.
• The thrombogenic potential of deep intertrabecular recesses in LVNC, even without ventricular dysfunction, is an area requiring further clarification.

Conclusions:

• The decision to initiate anticoagulant therapy in LVNC requires careful consideration of individual patient risk factors.
• Further research is needed to definitively establish the role of anticoagulation in LVNC patients with sinus rhythm and specific morphological features.
• The proposed flowchart aims to standardize and optimize anticoagulant therapy decisions in LVNC management.