What's the optimal duration of anticoagulation in patients with left ventricular thrombus?

IF 1.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Expert Review of Cardiovascular Therapy Pub Date : 2023-07-01 Epub Date: 2023-12-13 DOI:10.1080/14779072.2023.2270906

Fang Qin Goh, Ching-Hui Sia, Mark Y Chan, Leonard Ll Yeo, Benjamin Yq Tan

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Abstract

Introduction: Left ventricular thrombus (LVT) occurs in acute myocardial infarction and in ischemic and non-ischemic cardiomyopathies. LVT may result in embolic stroke. Currently, the duration of anticoagulation for LVT is unclear. This is an important clinical question as prolonged anticoagulation is associated with increased bleeding risks, while premature discontinuation may result in embolic complications.

Areas covered: There are no randomized trial data regarding anticoagulation duration for LVT. Guidelines and expert consensus recommend anticoagulation for 3-6 months with cessation of anticoagulation if interval imaging demonstrates thrombus resolution. Cardiac magnetic resonance imaging (CMR) is more sensitive and specific compared to echocardiography for LVT detection, and may be appropriate for high-risk patients. Prolonged anticoagulation may be considered in unresolved protuberant or mobile LVT, and in patients with resolved LVT but persistent depressed left ventricular ejection fraction and/or myocardial akinesia or dyskinesia.

Expert opinion: CMR will likely be increasingly used for LVT surveillance to guide anticoagulation duration. Further research is needed to determine which patients with persistent LVT on CMR benefit from prolonged anticoagulation.

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左心室血栓患者的最佳抗凝时间是多少？

引言：左心室血栓（LVT）发生在急性心肌梗死、缺血性和非缺血性心肌病中。LVT可能导致栓塞性中风。目前，LVT抗凝治疗的持续时间尚不清楚。这是一个重要的临床问题，因为长期抗凝会增加出血风险，而过早停药可能会导致栓塞并发症。涵盖的领域：没有关于LVT抗凝持续时间的随机试验数据。指南和专家共识建议3-6岁患者使用抗凝药物如果间隔成像显示血栓消退，则停止抗凝治疗数月。与超声心动图相比，心脏磁共振成像（CMR）检测LVT更灵敏、更特异，可能适用于高危患者。对于未解决的突起或活动性左心室T，以及左心室T已解决但左心室射血分数持续下降和/或心肌运动不全或运动障碍的患者，可考虑延长抗凝时间。专家意见：CMR可能越来越多地用于LVT监测，以指导抗凝持续时间。需要进一步的研究来确定哪些CMR持续性LVT患者从长期抗凝中受益。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Expert Review of Cardiovascular Therapy CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

3.70

自引率

0.00%

发文量

期刊介绍： Expert Review of Cardiovascular Therapy (ISSN 1477-9072) provides expert reviews on the clinical applications of new medicines, therapeutic agents and diagnostics in cardiovascular disease. Coverage includes drug therapy, heart disease, vascular disorders, hypertension, cholesterol in cardiovascular disease, heart disease, stroke, heart failure and cardiovascular surgery. The Expert Review format is unique. Each review provides a complete overview of current thinking in a key area of research or clinical practice.