Vitamin K antagonists remain the mainstay of therapy for left ventricular thrombus following acute myocardial infarction, as the efficacy of direct oral anticoagulants is less well established.
This review highlights that despite declining incidence, left ventricular thrombus post-myocardial infarction remains a serious complication best managed with vitamin K antagonists, with limited evidence for routine prophylaxis.
The incidence of left ventricular (LV) thrombus following acute myocardial infarction has markedly declined in recent decades caused by advancements in reperfusion and antithrombotic therapies. Despite this, embolic events remain the most feared complication of LV thrombus necessitating systemic anticoagulation. Mechanistically, LV thrombus development depends on Virchow's triad (ie, endothelial injury from myocardial infarction, blood stasis from LV dysfunction, and hypercoagulability triggered by inflammation, with each of these elements representing potential therapeutic targets). Diagnostic modalities include transthoracic echocardiography with or without ultrasound-enhancing agents and cardiac magnetic resonance. Most LV thrombi develop within the first 2 weeks post-acute myocardial infarction, and the role of surveillance imaging appears limited. Vitamin K antagonists remain the mainstay of therapy because the efficacy of direct oral anticoagulants is less well established. Only meager data support the routine use of prophylactic anticoagulation, even in high-risk patients.
Camaj et al. (2022) conducted a review in Left ventricular thrombus following acute myocardial infarction. Vitamin K antagonists remain the mainstay of therapy for left ventricular thrombus following acute myocardial infarction, as the efficacy of direct oral anticoagulants is less well established.