Key result
Three-month anticoagulation with DOACs or VKAs remains the preferred treatment for LV thrombus.
This review highlights that while DOACs and VKAs are used for 3 months to treat LV thrombus, more data is required to definitively prove DOAC noninferiority.
3-month DOAC or VKA anticoagulation may be used for LV thrombus; leaves open definitive RCT comparisons.
The incidence of left ventricular (LV) thrombus following acute myocardial infarction has declined significantly due to recent advancements in reperfusion and antithrombotic therapies. The development of LV thrombus depends on Virchow's triad: endothelial injury following myocardial infarction, blood stasis from LV dysfunction, and hypercoagulability. Diagnostic modalities for LV thrombus include transthoracic echocardiography and late gadolinium enhancement cardiac magnetic resonance imaging. Anticoagulation with direct oral anticoagulants or vitamin K antagonists for 3 months following initial diagnosis of LV thrombus remains the treatment of choice for LV thrombus. However, further evidence is needed to demonstrate the noninferiority of direct oral anticoagulants compared with vitamin K antagonists for the prevention of thromboembolic events.
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Feldman et al. (2023) conducted a review in Left ventricular thrombus. Direct oral anticoagulants or vitamin K antagonists was evaluated. Anticoagulation with direct oral anticoagulants or vitamin K antagonists for 3 months is the treatment of choice for left ventricular thrombus, though further comparative evidence is needed.
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