Left Ventricular Thrombus Following Myocardial Infarction: JACC State-of-the-Art Review

Anton Camaj, Valentin Fuster, Gennaro Giustino, Solomon W. Bienstock, David Sternheim, Roxana Mehran, George D. Dangas, Annapoorna Kini, Samin K. Sharma, Jonathan Halperin, Marc R. Dweck, Martin E. Goldman

Research output: Contribution to journalReview articlepeer-review

14 Scopus citations

Abstract

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.

Original languageEnglish
Pages (from-to)1010-1022
Number of pages13
JournalJournal of the American College of Cardiology
Volume79
Issue number10
DOIs
StatePublished - 15 Mar 2022

Keywords

  • acute myocardial infarction
  • anticoagulation
  • left ventricular thrombus

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