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Anticoagulation Strategies for Left Ventricular Thrombus After Myocardial Infarction: A Review
Adam Folman1, Nicola Toukan1, Ofer M Kobo1,2
1Division of Cardiovascular Medicine, Hillel Yaffe Medical Center, Hadera 3820302, Israel.
Journal of Clinical Medicine
|November 27, 2025
Summary
Direct oral anticoagulants (DOACs) show promise for treating left ventricular thrombus (LVT) after myocardial infarction (MI), offering better clot resolution and lower stroke risk than warfarin. Further research is needed for definitive guidance.
Area of Science:
- Cardiology
- Pharmacology
- Thrombosis Research
Background:
- Left ventricular thrombus (LVT) is a significant complication after myocardial infarction (MI).
- Warfarin has been the standard anticoagulant, but has limitations.
- Direct oral anticoagulants (DOACs) are emerging as alternatives.
Purpose of the Study:
- To review current evidence on anticoagulation strategies for LVT post-MI.
- To compare the efficacy and safety of DOACs versus warfarin.
- To identify gaps in current research and guide future studies.
Main Methods:
- Systematic review of 12 studies (9 retrospective cohorts, 3 RCTs).
- Analysis of patient populations from single-center cohorts to large registries.
- Comparison of outcomes including thrombus resolution, thromboembolic events, mortality, and bleeding.
Main Results:
- DOACs demonstrated higher thrombus resolution rates compared to warfarin.
- DOACs were associated with lower rates of stroke and systemic embolism.
- DOACs showed similar mortality and marginally reduced major bleeding risk versus warfarin.
Conclusions:
- DOACs may offer comparable efficacy and improved safety for LVT post-MI.
- Current evidence is limited by small, underpowered randomized trials.
- Individualized treatment balancing risks and benefits is recommended pending larger studies.
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