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

Figures & Tables

LVT	Recommendation
STEMI Guidelines
ACC/AHA-2013¹³
Patient with STEMI and	DAPT+VKA with INR target 2–2.5
asymptomatic LVT at high risk of developing LVT
ESC 2012
LVT	VKA for a minimum of 3 months
ESC 2017¹⁵
LVT	Anticoagulation 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 CAD	VKA for 3 months with INR target 2–3