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Management of Left Ventricular Thrombus

      The optimal management of left ventricular thrombus (LVT) remains controversial. Despite decreasing incidence with improvements in early percutaneous revascularization, LVT is estimated to occur after 6.3% of ST elevation myocardial infarctions.
      • Bulluck H
      • Chan MHH
      • Paradies V
      • Yellon RL
      • Ho HH
      • Chan MY
      • Chin CWL
      • Tan JW
      • Hausenloy DJ.
      Incidence and predictors of left ventricular thrombus by cardiovascular magnetic resonance in acute ST-segment elevation myocardial infarction treated by primary percutaneous coronary intervention: a meta-analysis.
      Because a key tenet of Virchow's triad for thrombosis includes blood stasis, nonischemic cardiomyopathy remains another, although less frequent, cause of LVT. Variability in etiology may add to the elusiveness of determining an optimal therapy. Nevertheless, LVT remains a pertinent pathology for patients and clinicians.
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      References

        • Bulluck H
        • Chan MHH
        • Paradies V
        • Yellon RL
        • Ho HH
        • Chan MY
        • Chin CWL
        • Tan JW
        • Hausenloy DJ.
        Incidence and predictors of left ventricular thrombus by cardiovascular magnetic resonance in acute ST-segment elevation myocardial infarction treated by primary percutaneous coronary intervention: a meta-analysis.
        J Cardiovasc Magn Reson. 2018; 20: 72
        • Giugliano RP
        • Ruff CT
        • Braunwald E
        • Murphy SA
        • Wiviott SD
        • Halperin JL
        • Waldo AL
        • Ezekowitz MD
        • Weitz JI
        • Špinar J
        • Ruzyllo W
        • Ruda M
        • Koretsune Y
        • Betcher J
        • Shi M
        • Grip LT
        • Patel SP
        • Patel I
        • Hanyok JJ
        • Mercuri M
        • Antman EM
        • ENGAGE AF-TIMI 48 Investigators
        Edoxaban versus warfarin in patients with atrial fibrillation.
        N Engl J Med. 2013; 369: 2093-2104
        • Connolly SJ
        • Ezekowitz MD
        • Yusuf S
        • Eikelboom J
        • Oldgren J
        • Parekh A
        • Pogue J
        • Reilly PA
        • Themeles E
        • Varrone J
        • Wang S
        • Alings M
        • Xavier D
        • Zhu J
        • Diaz R
        • Lewis BS
        • Darius H
        • Diener HC
        • Joyner CD
        • Wallentin L
        • RE-LY Steering Committee and Investigators
        Dabigatran versus warfarin in patients with atrial fibrillation.
        N Engl J Med. 2009; 361 ([published correction appears in N Engl J Med 2010;363:1877]): 1139-1151
        • Patel MR
        • Mahaffey KW
        • Garg J
        • Pan G
        • Singer DE
        • Hacke W
        • Breithardt G
        • Halperin JL
        • Hankey GJ
        • Piccini JP
        • Becker RC
        • Nessel CC
        • Paolini JF
        • Berkowitz SD
        • Fox KA
        • Califf RM
        • ROCKET AF Investigators
        Rivaroxaban versus warfarin in nonvalvular atrial fibrillation.
        N Engl J Med. 2011; 365: 883-891
        • Büller HR
        • Prins MH
        • Lensin AW
        • Decousus H
        • Jacobson BF
        • Minar E
        • Chlumsky J
        • Verhamme P
        • Wells P
        • Agnelli G
        • Cohen A
        • Berkowitz SD
        • Bounameaux H
        • Davidson BL
        • Misselwitz F
        • Gallus AS
        • Raskob GE
        • Schellong S
        • Segers A
        • EINSTEIN–PE Investigators
        Oral rivaroxaban for the treatment of symptomatic pulmonary embolism.
        N Engl J Med. 2012; 366: 1287-1297
        • Agnelli G
        • Gallus A
        • Goldhaber SZ
        • Haas S
        • Huisman MV
        • Hull RD
        • Kakkar AK
        • Misselwitz F
        • Schellong S
        • ODIXa-DVT Study Investigators
        Treatment of proximal deep-vein thrombosis with the oral direct factor Xa inhibitor rivaroxaban (BAY 59–7939): the ODIXa-DVT (Oral Direct Factor Xa Inhibitor BAY 59–7939 in Patients With Acute Symptomatic deep-vein thrombosis) study.
        Circulation. 2007; 116: 180-187
        • Eikelboom JW
        • Connolly SJ
        • Brueckmann M
        • Granger CB
        • Kappetein AP
        • Mack MJ
        • Blatchford J
        • Devenny K
        • Friedman J
        • Guiver K
        • Harper R
        • Khder Y
        • Lobmeyer MT
        • Maas H
        • Voigt JU
        • Simoons ML
        • Van de Werf F
        • RE-ALIGN Investigators
        Dabigatran versus warfarin in patients with mechanical heart valves.
        N Engl J Med. 2013; 369: 1206-1214
        • Daher J
        • Da Costa A
        • Hilaire C
        • Ferreira T
        • Pierrard R
        • Guichard JB
        • Romeyer C
        • Isaaz K
        Management of left ventricular thrombi with direct oral anticoagulants: retrospective comparative study with vitamin K antagonists.
        Clin Drug Investig. 2020; 40: 343-353
        • Guddeti RR
        • Anwar M
        • Walters RW
        • Apala D
        • Pajjuru V
        • Kousa O
        • Gujjula NR
        • Alla VM
        Treatment of left ventricular thrombus with direct oral anticoagulants: a retrospective observational study.
        Am J Med. 2020; 133: 1488-1491
        • Iqbal H
        • Straw S
        • Craven TP
        • Stirling K
        • Wheatcroft SB
        • Witte KK.
        Direct oral anticoagulants compared to vitamin K antagonist for the management of left ventricular thrombus.
        ESC Heart Fail. 2020; 7: 2032-2041
        • Jones DA
        • Wright P
        • Alizadeh MA
        • Fhadil S
        • Rathod KS
        • Guttmann O
        • Knight C
        • Timmis A
        • Baumbach A
        • Wragg A
        • Mathur A
        • Antoniou S.
        The use of novel oral anticoagulants compared to vitamin K antagonists (warfarin) in patients with left ventricular thrombus after acute myocardial infarction.
        Eur Heart J Cardiovasc Pharmacother. 2021; 7: 398-404
        • Robinson AA
        • Trankle CR
        • Eubanks G
        • Schumann C
        • Thompson P
        • Wallace RL
        • Gottiparthi S
        • Ruth B
        • Kramer CM
        • Salerno M
        • Bilchick KC
        • Deen C
        • Kontos MC
        • Dent J.
        Off-label use of direct oral anticoagulants compared with warfarin for left ventricular thrombi.
        JAMA Cardiol. 2020; 5: 685-692
        • Bass ME
        • Kiser TH
        • Page 2nd, RL
        • McIlvennan CK
        • Allen LA
        • Wright G
        • Shakowski C
        Comparative effectiveness of direct oral anticoagulants and warfarin for the treatment of left ventricular thrombus.
        J Thromb Thrombolysis. 2021; 52: 517-522
        • Ali Z
        • Isom N
        • Dalia T
        • Sami F
        • Mahmood U
        • Shah Z
        • Gupta K.
        Direct oral anticoagulant use in left ventricular thrombus.
        Thromb J. 2020; 18: 29
        • Abdelnabi M
        • Saleh Y
        • Fareed A
        • Nossikof A
        • Wang L
        • Morsi M
        • Eshak N
        • Abdelkarim O
        • Badran H
        • Almaghraby A.
        Comparative study of oral anticoagulation in left ventricular thrombi (No-LVT Trial).
        J Am Coll Cardiol. 2021; 77: 1590-1592
        • Camaj A
        • Fuster V
        • Giustino G
        • Bienstock SW
        • Sternheim D
        • Mehran R
        • Dangas GD
        • Kini A
        • Sharma SK
        • Halperin J
        • Dweck MR
        • Goldman ME.
        Left ventricular thrombus following acute myocardial infarction: JACC state-of-the-art review.
        J Am Coll Cardiol. 2022; 79: 1010-1022
      1. Seiler T, Vasiliauskaite E, Grüter D, Young M, Attinger-Toller A, Madanchi M, Cioffi GM, Tersalvi G, Müller G, Stämpfli SF, de Boeck B, Suter Y, Nossen J, Toggweiler S, Wuillemin WA, Cuculi F, Kobza R, Bossard M. Direct oral anticoagulants versus vitamin K antagonists for the treatment of left ventricular Thrombi-Insights from a Swiss multicenter registry. Am J Cardiol. 2023.