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Left ventricular thrombus recurrence after anticoagulation discontinuation

Kamran Namjouyan1, Aastha Mittal1, Seth Krueger1

  • 1Medicine Institute, Geisinger Medical Center, Danville, PA, USA.

International Journal of Cardiology. Heart & Vasculature
|August 26, 2024
PubMed

Insights

Left ventricular thrombus (LVT) recurrence occurs in 10.3% of Anterior ST-segment elevation myocardial infarction (STEMI) patients after anticoagulation discontinuation. Ventricular aneurysm and multi-vessel disease increase recurrence risk, necessitating further research on optimal anticoagulation duration.

Area of Science:

  • Cardiology
  • Cardiovascular Medicine
  • Thrombosis Research

Background:

  • Left ventricular thrombus (LVT) is a complication of Anterior ST-segment elevation myocardial infarction (STEMI).
  • Optimal anticoagulation (AC) duration for LVT remains unclear.
  • Limited evidence exists on LVT recurrence after AC discontinuation in STEMI patients.

Purpose of the Study:

  • To evaluate the rate of LVT recurrence in Anterior STEMI patients.
  • To identify risk factors associated with LVT recurrence.
  • To inform clinical decisions regarding anticoagulation therapy duration.

Main Methods:

  • Retrospective analysis of 87 Anterior STEMI patients with LVT and reduced ejection fraction (<35%).
  • Exclusion of patients with atrial fibrillation or hypercoagulable states.
  • Comparison of demographic, comorbidity, treatment, and imaging characteristics between patients with and without LVT recurrence.

Main Results:

  • Left ventricular thrombus recurrence was observed in 10.3% of patients.
  • Patients with recurrence were more likely to have ventricular aneurysm/scarring (33% vs 10.3%) and multi-vessel disease (22.2% vs 9%).
  • Three of nine patients with recurrence (33.3%) experienced cardioembolic events.

Conclusions:

  • A subset of Anterior STEMI patients with LVT face a significant risk of recurrence after discontinuing anticoagulation.
  • Ventricular aneurysm and multi-vessel disease are potential risk factors for LVT recurrence.
  • Prospective trials are essential to determine the appropriate duration of anticoagulation therapy for LVT.
Abstract

Keywords:
Anterior ST elevation myocardial infarctionHeart failure with reduced ejection fractionLeft ventricular thrombus

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