Management of Patients at Risk for and With Left Ventricular Thrombus

Publication Date: September 15, 2022
Last Updated: October 5, 2022


Table 1. Eight Key Clinical Management Issues Related to the Management of Patients at Risk for and With LV Thrombus

Having trouble viewing table?
  • Is echocardiography adequate for detection of suspected LV thrombus, or is CMR (or cardiac CT) indicated when there is concern for LV thrombus?
  • In the era of DAPT after ACS and PCI, which patients should be consid-ered for OAC therapy after anterior/apical MI and akinesis, particularly given the increased bleeding rates with combined OAC therapy and antiplatelet therapy?
  • In those patients with acute MI with visualized LV thrombus, when (if ever) can anticoagulation be stopped? Is a single echocardiogram after 3–6 mo of therapy not demonstrating LV thrombus enough to confidently discontinue?
  • Which, if any, patients with DCM or HFrEF (not related to acute MI) should be treated with preventive (prophylactic) OAC?
  • In those with DCM or HFrEF who form LV thrombus and thus may have a predilection to do this, can OAC ever be stopped (even if a follow-up echocardiogram demonstrates LV thrombus resolution)?
  • Is anticoagulation really indicated for laminated thrombus (not a more mobile, round, mural thrombus)?
  • Is DOAC a reasonable alternative to warfarin for the prevention and treat-ment of LV thrombus?
  • What management options are there in patients with persistent LV throm-bus despite therapy?



Management of Patients at Risk for and With Left Ventricular Thrombus

Authoring Organization