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Anticoagulation for Left Ventricular Thrombosis Post-Myocardial Infarction – Current Recommendations and Future Perspectives Cover

Anticoagulation for Left Ventricular Thrombosis Post-Myocardial Infarction – Current Recommendations and Future Perspectives

Romanian Journal of Cardiology
Volume 32 (2022): Issue 1 (March 2022)
By: ,  ,  ,  ,   and    
Open Access
|Jun 2022
Figures & tables

Figures & Tables

Figure 1

Virchow's triad adapted for left ventricular thrombosis (LVT) (modified after Delewi, et al.5).

Figure 2

Transthoracic echocardiography of the left ventricle. Thrombus (arrows) attached to the apical septal wall in a patient with ischemic cardiomyopathy.

Figure 3

Algorithm for the diagnosis of LVT in reperfused STEMI patients. Abbreviations: LV – left ventricle, TTE – transthoracic echocardiography, CMR – cardiac magnetic resonance imaging (adapted after Bulluck, et al.12)

Table 1

Guidelines for management of left ventricular thrombosis

LVTRecommendation
  STEMI Guidelines
ACC/AHA-201313
Patient with STEMI andDAPT+VKA with INR target 2–2.5

  • asymptomatic LVT

  • at high risk of developing LVT

ESC 2012
LVTVKA for a minimum of 3 months
ESC 201715
LVTAnticoagulation should be administered for up to 6 months guided by repeated imaging
  Stroke Guidelines
AHA/ASA 201416
Patient with ischemic stroke or TIA:

  • in setting of acute MI complicated by LVT

    • VKA therapy intolerance

  • in setting of acute MI at high risk of LVT

  • VKA for 3 months (INR target 2–3)

    • LMWH or DOAC (rivaroxaban, apixaban or dabigatran) for 3 months

  • Consider VKA therapy (INR target 2–3)

AHA/ASA 202117
Patient with stroke or TIA:

  • LVT

  • new LVT (< 3 months)

  • in setting of acute MI at high risk of LVT

  • warfarin for at least 3 months

  • the safety of anticoagulation with DOAC is uncertain

  • empirical anticoagulation for 3 months

  CHEST guidelines
ACCP 201218
Patient with anterior MI + LVT/high risk for LVT

  • with no stent

  • PCI with BMS

  • PCI with DES

  • VKA + low dose of aspirin for 3 months

  • triple therapy (VKA + aspirin + clopidogrel) for 1 month, then VKA + one antiplatelet for the next 2 months

  • triple therapy (VKA + aspirin + clopidogrel) for 3–6 months

Then discontinue warfarin and continue DAPT for up to 12 months as per ACS recommendation
Patient with LV systolic dysfunction + LVT without CADVKA for 3 months with INR target 2–3

[i] Abbreviations: LVT, left ventricular thrombosis; STEMI-ST, elevation acute myocardial infarction; ACC/AHA, American College of Cardiology/American Heart Association; ESC, European Society of Cardiology; DAPT, dual antiplatelet therapy; VKA, vitamin K antagonist; INR, international normalized ratio; AHA/ASA, American Heart Association/American Stroke Association; TIA, transient ischemic attack; LMWH, low-molecular-weight heparin; MI, myocardial infarction; DOAC, direct oral anticoagulant; PCI, percutaneous coronary intervention; BMS, bare metal stent; DES, drug-eluting stent; ACS, acute coronary syndrome; CAD, coronary artery disease; LV, left ventricle.

DOI: https://doi.org/10.2478/rjc-2022-0005 | Journal eISSN: 2734-6382 | Journal ISSN: 1220-658X
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Language: English, Romanian
Page range: 22 - 27
Published on: Jun 4, 2022
Published by: Romanian Society of Cardiology
In partnership with: Paradigm Publishing Services
Publication frequency: 4 issues per year
Keywords:
Left ventricular thrombosis,
vitamin K antagonists,
direct oral anticoagulants,
anticoagulation,
treatment
Related subjects:
Medicine,
Clinical medicine,
Internal medicine,
Cardiology,
Pediatrics and juvenile medicine,
Paediatric cardiology,
Surgery,
Cardiac surgery

© 2022 Mihai Ștefan Cristian Haba, Andreea-Simona Ungurenașu, Elena Cosmina Ciobanu, Florin Mitu, Radu Stefan Miftode, Ovidiu Mitu, published by Romanian Society of Cardiology
This work is licensed under the Creative Commons Attribution 4.0 License.

Volume 32 (2022): Issue 1 (March 2022)
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