Left Ventricular Thrombosis in Ischemic and Non-Ischemic Cardiomyopathies: Focus on Evidence-Based Treatment

Area of Science:

• Cardiology
• Cardiovascular Imaging
• Thrombosis Research

Background:

• Left ventricular thrombosis (LVT) is a serious complication of ischemic and non-ischemic heart disease.
• While incidence has decreased due to reperfusion therapies, LVT remains a significant concern.
• Accurate diagnosis and effective treatment are crucial for patient outcomes.

Purpose of the Study:

• To review diagnostic modalities for LVT.
• To discuss current treatment strategies, including anticoagulation.
• To highlight areas needing further research, such as DOAC efficacy and optimal treatment duration.

Main Methods:

• Review of diagnostic tools, emphasizing echocardiography and cardiac magnetic resonance.
• Analysis of anticoagulant therapies, including Vitamin K antagonists and DOACs.
• Discussion of treatment duration based on underlying cardiopathy and follow-up.

Main Results:

• Echocardiography is the primary diagnostic tool for LVT, with advanced imaging used when inconclusive.
• Vitamin K antagonists have been the traditional treatment, but DOACs are increasingly used off-label.
• A 3-6 month anticoagulation course is suggested for ischemic cardiopathy, with duration debated for non-ischemic cases.

Conclusions:

• High-quality randomized trials are needed to establish evidence for DOAC use in LVT.
• Further research should investigate prophylactic anticoagulation in high-risk patients.
• Optimal anticoagulation duration for LVT, particularly in non-ischemic cardiomyopathy, requires clarification.