Massive Thrombosis of the Left Ventricle

Shapiro, Ruben L.; Olivetti, Renzo G.

doi:10.1161/01.cir.30.3.425

Cited by 4 publications

(1 citation statement)

References 7 publications

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“…There are only a few anecdotal reports on the management of giant, huge, massive, or obliterating thrombus, including treatment with DOAC, fibrinolytic therapy, and surgical resection. [116][117][118][119][120] In unusual circumstances, thrombus size may affect diastolic ventricular volume or obstruct either mitral inflow or aortic outflow. There are insufficient data to preferentially recommend any one approach to large or massive LV thrombi, and these rare scenarios are best addressed with a multidisciplinary approach to therapeutic intervention.…”

Section: Management Of Massive LV Thrombusmentioning

confidence: 99%

Management of Patients at Risk for and With Left Ventricular Thrombus: A Scientific Statement From the American Heart Association

Levine¹,

McEvoy²,

Fang³

et al. 2022

Circulation

136

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Despite the many advances in cardiovascular medicine, decisions concerning the diagnosis, prevention, and treatment of left ventricular (LV) thrombus often remain challenging. There are only limited organizational guideline recommendations with regard to LV thrombus. Furthermore, management issues in current practice are increasingly complex, including concerns about adding oral anticoagulant therapy to dual antiplatelet therapy, the availability of direct oral anticoagulants as a potential alternative option to traditional vitamin K antagonists, and the use of diagnostic modalities such as cardiac magnetic resonance imaging, which has greater sensitivity for LV thrombus detection than echocardiography. Therefore, this American Heart Association scientific statement was commissioned with the goals of addressing 8 key clinical management questions related to LV thrombus, including the prevention and treatment after myocardial infarction, prevention and treatment in dilated cardiomyopathy, management of mural (laminated) thrombus, imaging of LV thrombus, direct oral anticoagulants as an alternative to warfarin, treatments other than oral anticoagulants for LV thrombus (eg, dual antiplatelet therapy, fibrinolysis, surgical excision), and the approach to persistent LV thrombus despite anticoagulation therapy. Practical management suggestions in the form of text, tables, and flow diagrams based on careful and critical review of actual study data as formulated by this multidisciplinary writing committee are given.

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