Key result
This educational review proposes an algorithm for the prevention and treatment of left ventricular thrombosis and highlights the potential of direct oral anticoagulants in its management.
Why the study?
Many aspects of left ventricular thrombus management remain in a grey area of evidence, driven by limited pathophysiological understanding, underestimation by standard imaging, and the rapid development of direct oral anticoagulants.
Answers are grounded in this paper and cite their sources.
This review provides an updated algorithm for the prevention, diagnosis, and treatment of left ventricular thrombus, emphasizing the emerging role of direct oral anticoagulants and multimodality imaging.
Heightened interest in left ventricular thrombus (LVT) stems from the consistent association of subsequent stroke and systemic embolism after LVT, and many aspects of its management still exist in a grey area of evidence. The current delay in intervention is likely related to a limited understanding of the disease pathophysiology, along with an underestimation of LVT by standard imaging modalities. With the rapid development of antithrombotic regimens consisting of direct oral anticoagulants (OACs), which have shown early safety and efficacy, there is a growing need to understand and accurately diagnose the LVT process in order to determine appropriate management solutions. This educational review will oversee LVT pathophysiology, current status of the guidelines-recommended echocardiographic approach and the role of multimodality imaging, as well as prevention and treatment modalities in the modern era. Meanwhile, the review proposes an algorithm for the prevention and treatment of LVT based on current guidelines and expert consensus, and highlights the need for more investigations to identify risk stratification methods for individual patients, and lastly, discusses the potential of direct OACs in the management of LVT.
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Zhang et al. (2025) conducted a review in Left ventricular thrombosis. Direct oral anticoagulants (OACs) was evaluated. This educational review proposes an algorithm for the prevention and treatment of left ventricular thrombosis and highlights the potential of direct oral anticoagulants in its management.
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