One-year clinical outcome of patients with left ventricular thrombus after acute myocardial infarction discharged on triple or dual antithrombotic therapy

Luca, Leonardo De; Putini, Rita Lucia; Natale, Enrico; Terranova, Antonino; Piazza, V Di; Pugliese, Marco; Lio, Lucia De; Biffani, Elisabetta; Bellettini, Elisa; Uguccioni, Massimo; Musumeci, Francesco

doi:10.1007/s11239-021-02577-2

Cited by 4 publications

(8 citation statements)

References 34 publications

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“…De Luca et al . [17] investigated 1-year outcomes for patients with triple vs. dual antithrombotic therapy and found in their study of 83 patients that dual therapy was more effective in reducing adverse clinical outcomes, especially early bleeding complications. Hooks et al .…”

Section: Resultsmentioning

confidence: 99%

“…A total of 39 studies were included in this systematic review of LVT [9–47]. The process of study selection is shown in Supplementary Figure 1, Supplemental digital content 1, http://links.lww.com/MCA/A554.…”

Section: Resultsmentioning

confidence: 99%

“…There were a few studies which merit discussion. De Luca et al [17] investigated 1-year outcomes for patients with triple vs. dual antithrombotic therapy and found in their study of 83 patients that dual therapy was more effective in reducing adverse clinical outcomes, especially early bleeding complications. Hooks et al [24] evaluated 1-year embolic events in patients with LVT and found that these events occurred in 8.3% of the subgroup with nonischemic cardiomyopathy compared to 6.5% for those with ischemic cardiomyopathy.…”

Section: Resultsmentioning

confidence: 99%

“…This raises the issue of dual vs. triple therapy with anticoagulation as antiplatelet therapy on top of anticoagulation will expose patients to high bleeding risk. In the current review, only one study [17] focused on this question about dual vs. triple therapy, and this study found that dual therapy appeared to be safer compared to triple therapy. These findings are in line with current trends and recommendations from guidelines and trials investigating patients with dual antiplatelet therapy after PCI [50,51].…”

Section: Discussionmentioning

confidence: 99%

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An evidence-based evaluation of left ventricular thrombus treatment, outcomes, and resolution: a systematic review, pooled analysis and meta-analysis

Kwok

Bennett

Borovac

et al. 2023

Coronary Artery Disease

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Left ventricular thrombus (LVT) is a recognized complication of acute myocardial infarction which is associated with stroke. There has yet to be a published systematic review that focuses on outcomes for patients with LVT. We conducted a systematic review on treatments, adverse events and thrombus resolution in patients with LVT. Meta-analysis and numerical pooling were used to evaluate the difference in outcomes based on treatment and the presence or absence of LVT. A total of 39 studies were included (5475 patients with LVT and 356 589 patients with no LVT). The use of direct oral anticoagulants (DOACs) was associated with reduced mortality [RR, 0.66; 95% confidence interval (CI), 0.45–0.97; I2 = 9%] and bleeding (RR, 0.64; 95% CI, 0.48–0.85; I2 = 0%) compared to warfarin but there was a nonsignificant reduction in stroke/embolic events (RR, 0.95; 95% CI, 0.76–1.19; I2 = 3%). For patients with any treatment, the rate of stroke/embolic events, bleeding and mortality at follow-up of up to 12 months was 6.4, 3.7 and 7.9%, respectively. Pooled results from six studies that evaluated resolution at 6 months suggest that 80% of LVT were resolved. Apixaban was associated with the highest rate of (93.3%) whereas warfarin exhibited the lowest rate of resolution 73.1%. LVT is best managed with DOAC compared to warfarin therapy. An individualized approach to antithrombotic therapy is warranted as there appears to be no duration of therapy that clearly results in the resolution of all cases of LVT so follow-up imaging after discontinuation of anticoagulant is needed.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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An evidence-based evaluation of left ventricular thrombus treatment, outcomes, and resolution: a systematic review, pooled analysis and meta-analysis

Kwok

Bennett

Borovac

et al. 2023

Coronary Artery Disease

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“…17,27,30,39,40 Eight studies each (25.0%) described a median duration of OAC treatment of between 3 and 6 months, seven studies (21.9%) described a treatment duration of 6-12 months and seven studies (18.8%) described a median treatment duration of >12 months. [16][17][18][19]21,23,24,28,30,[32][33][34][35][36][37]41,43,46 The median time to LVT resolution ranged from 2 to 3.4 months for DOACs and from 4 to 9 months for VKAs, with 70-86% of patients on DOACs and 49-76% of patients on VKAs achieving LVT resolution by 12 months. 13,30,46 Five studies found a significantly shorter time to resolution with DOACs compared with VKAs.…”

Section: Initial Anticoagulation Strategymentioning

confidence: 99%

Contemporary Review of the Management of Left Ventricular Thrombus

Jiang

Cader

Al-Omary

et al. 2023

J Asian Pac Soc Cardiol

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Although there is established evidence for the treatment of left ventricular thrombus (LVT) at the outset, the subsequent management of these patients is less well-defined. This review discusses the currently available evidence for the initial type and duration of anticoagulation for LVT and explores potential treatment options after the initial period of anticoagulation. Of 2,052 studies screened, 32 studies (with three randomised controlled trials) were included. The initial anticoagulation strategy was either warfarin or direct oral anticoagulants, with the majority of studies showing similar outcomes. If LVT persists, studies recommended continuing anticoagulation (n=11/17) or switching to a different class of anticoagulant (n=7/17). After resolution, five studies recommended continuing anticoagulation in the presence of high-risk features of recurrence (i.e. persistently depressed left ventricular ejection fraction and/or apical wall dyskinesia). Medical management should be optimised, together with the appropriate revascularisation strategy, as clinically indicated. Synthesising the evidence, a practical algorithm for the management of LVT is proposed.

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