Left Ventricular Thrombus in Oncology Patients and Beyond: Imaging, Treatment Choices, and Duration

BackgroundLeft ventricular thrombus (LVT) is a significant complication linked to myocardial infarction and marked left ventricular dysfunction. its detection has increased among oncology patients; this may be attributed to the cardiotoxic effects of cancer therapies. The prothrombotic state occur in cancer which is caused by factors include hypercoagulability, persistent systemic inflammation, and endothelial injury promote an environment conducive to thrombus formation.MethodsA comprehensive review was conducted through PubMed, Scopus, and leading cardiology and oncology society guidelines up to October 2025. Relevant studies were analyzed to provide an overview of the epidemiology, mechanisms, diagnostic imaging approaches, treatment strategies, and prognosis of left ventricular thrombus in both oncology and non-oncology populations.ResultsLVT occurred in approximately 4%-15% of patients after myocardial infarction, with an increased incidence among those with chemotherapy-induced cardiomyopathy. Transthoracic echocardiography (TTE) is the initial diagnostic test, while cardiac magnetic resonance imaging (CMR) with late gadolinium enhancement is the gold standard. Anticoagulation with either vitamin K antagonists or direct oral anticoagulants (DOACs) effectively reduces embolic risk. Oncology patients pose additional concerns, because they had increased bleeding risk and potential drug interactions. Currently, both American Heart Association (AHA) and European Society of Cardiology (ESC) guidelines lack cancer-specific recommendations.ConclusionLVT in oncology patients results from a combination of factors, including cancer-related thrombosis and therapy-induced cardiac dysfunction factors. Early detection and individualized anticoagulation are important. More specific studies are urgently required to establish optimal therapy duration, cancer-specific cardio-oncology guidelines to enhance safety and outcomes.