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Prothrombotic fibrin clot phenotype as a risk factor for persistent left ventricular thrombus following acute

Krystian Mróz1, Elżbieta Paszek2, Maciej Polak3

  • 1Clinical Department of Interventional Cardiology, St. John Paul II Hospital, Kraków, Poland.

Journal of Thrombosis and Haemostasis : JTH
|June 12, 2025
PubMed

Insights

Dense, poorly lysable fibrin clots are linked to anticoagulation failure in ST-segment elevation myocardial infarction (MI) patients with left ventricular thrombus (LVT). These prothrombotic clot properties may be associated with NETosis, impacting treatment outcomes.

Area of Science:

  • Cardiovascular Medicine
  • Hematology
  • Biochemistry

Background:

  • Left ventricular thrombus (LVT) affects up to 15% of ST-segment elevation myocardial infarction (MI) patients.
  • LVT can persist in 30% of patients despite anticoagulation therapy.
  • Dense, poorly lysable fibrin clots are hypothesized to contribute to LVT persistence.

Purpose of the Study:

  • To investigate if unfavorable fibrin clot properties are associated with LVT resolution.
  • To identify determinants of these fibrin clot properties in MI patients.

Main Methods:

  • 149 patients with LVT post-MI were studied.
  • Fibrin clot permeability (Ks), clot lysis time (CLT), plasminogen activator inhibitor-1 (PAI-1), and citrullinated histone H3 (citH3) were measured.
  • LVT resolution was assessed at 3 and 6 months after MI.

Main Results:

  • Patients with persistent LVT at 3 months had lower Ks, longer CLT, and higher PAI-1 and citH3 levels.
  • Persistent LVT at 6 months also showed an unfavorable clot phenotype.
  • Lower Ks and longer CLT were independently associated with LVT persistence.

Conclusions:

  • Prothrombotic fibrin clot properties are associated with anticoagulation failure in LVT complicating acute MI.
  • Enhanced NETosis may contribute to these unfavorable clot properties.
  • This finding is the first to link clot phenotype to treatment resistance in LVT.
Abstract

Keywords:
extracellular trapsfibrinfibrin clot lysis timemyocardial infarctionthrombosis

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