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Management of Patients at Risk for and With Left Ventricular Thrombus
Publication Date: September 15, 2022
Last Updated: October 5, 2022
Tables
Table 1. Eight Key Clinical Management Issues Related to the Management of Patients at Risk for and With LV Thrombus
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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?
Overview
Title
Management of Patients at Risk for and With Left Ventricular Thrombus
Authoring Organization
American Heart Association
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