Resolution Of Left Ventricular Thrombus Research Articles

A meta-summary of case reports of non-vitamin K antagonist oral anticoagulant use in patients with left ventricular thrombus.

Left ventricular (LV) thrombus is commonly seen in patients with extensive anterior ST-elevation myocardial infarction. The standard of care for LV thrombus is anticoagulation with warfarin. However, there has been an increasing trend of case reports using non-vitamin K antagonist oral anticoagulants (NOAC) for the treatment of LV thrombus. This study aimed to perform a meta-summary of the literature to characterise and evaluate the safety and feasibility of using NOAC in patients with LV thrombus. We searched for articles published in four electronic databases: PubMed, EMBASE, Scopus and Google Scholar using an appropriate keyword/MeSH term search strategy. Twenty-four studies comprising 36 patients were included in the analysis. Rivaroxaban was used in majority of patients (47.2%), whilst Apixaban and Dabigatran were prescribed in 25.0% and 27.8% of patients respectively. The most commonly associated risk factor found was post-acute myocardial infarction in 15 patients (41.7%). LV thrombus resolution was met by most patients (87.9%), and the median duration of treatment to resolution was 30.0days (IQR = 22.5-47.0). One non-fatal bleeding event (3.0%) and no embolic events were reported. The use of NOAC may have a role in the treatment of LV thrombus in selected patients. Further randomized controlled trials are needed to evaluate this treatment strategy.

Efficacy of Target Specific Oral Anticoagulants on the Resolution of Left Ventricular Thrombus

Efficacy of Target Specific Oral Anticoagulants on the Resolution of Left Ventricular Thrombus

Oral factor Xa inhibitors for the treatment of left ventricular thrombus: a case series

Left ventricular thrombus (LVT) formation usually necessitates short term anticoagulation for thrombus resolution and to prevent embolic events. Historically, vitamin K antagonist therapy has been the treatment of choice. However, with the advent of direct acting anticoagulants, their role in the management of LVT is not clear. Patients were included if they had received rivaroxaban or apixaban for more than 1 day for LVT documented on imaging. The primary objective was resolution of LVT at 3 months based on assessment by an independent cardiologist review of initial and subsequent imaging results. The principle safety objective was to assess major or clinically relevant non-major bleeding using GUSTO, TIMI, and BARC bleeding criteria. During the 2-year study period seven patients were treated with rivaroxaban and three with apixaban. Two patients who had received apixaban and one on rivaroxaban were lost to follow up. In those with an initial and follow-up ECHO (n = 6) the median time to follow up imaging was 214 (IQR 33-414) days and complete LVT resolution was observed in 83% of patients. One patient on rivaroxaban had a bleeding events that was minimal (TIMI), Type 2 (BARC), or classified as mild (GUSTO) due to pulmonary hemorrhage. In those deemed not to be a candidate for vitamin K antagonist the use of rivaroxaban or apixaban may be a considered in the treatment of LVT. Further research in this area is needed to assess the efficacy and safety of using FXAI for treatment of LVT.

Dabigatran Effect on Left Ventricular Thrombus in a Patient with Acute Ischemic Stroke.

Dabigatran Effect on Left Ventricular Thrombus in a Patient with Acute Ischemic Stroke.

Dabigatran for left ventricular thrombus

Male patient in dilated phase of hypertrophic cardiomyopathy had multiple hospitalizations during the past 2 years either due to congestive heart failure, stroke, scar epilepsy, or atrial fibrillation and ventricular tachycardia. Medication included evidence based therapy for heart failure, cordarone and warfarin. Anticoagulation had to be discontinued due to marked fluctuations in INR. Transthoracic Echocardiography (TTE) revealed a mobile mass in the left ventricle. He was treated with Dabigatran 110mg twice a day for 4 months without any bleeding or embolic episode and complete resolution of thrombus.Dabigatran is a reversible direct thrombin inhibitor and currently approved for the prevention of thromboembolic episodes in non-valvar atrial fibrillation. This case demonstrates possible thrombolytic properties of dabigatran in resolution of left ventricular thrombus.

Resolution of Left Ventricular Thrombus after Dabigatran Therapy in Two Patients with Old Anteroseptal Myocardial Infarction

Dabigatran has been used recently as an alternative to warfarin therapy for the prevention of thromboembolism in patients with myocardial infarction or atrial fibrillation, but treatment of established intracardiac thrombus with dabigatran has seldom been reported. We report two patients with left ventricular (LV) thrombus who were successfully treated with dabigatran. The first patient was a 52-year-old man with no clear symptoms who was referred for investigation of abnormal electrocardiography findings, and the second patient was a 51-year-old man with recent onset of heart failure and a history of chest pain 1 month previously. Both patients were diagnosed with old anteroseptal myocardial infarction after echocardiography showed abnormal LV wall motion and LV thrombus. The thrombus was thought to be chronic in the first patient, and to have formed within the preceding month in the second patient. After treatment with dabigatran 220 mg/day and antiplatelet drugs, repeat echocardiography showed resolution of the thrombus after 6 weeks and 2 weeks, respectively. These cases illustrate that dabigatran 220 mg/ day may be useful for the treatment of established LV thrombus.

C0104: Resolution of Left Ventricular Thrombus in a Patient with Dilated Cardiomyopathy by Rivaroxaban

C0104: Resolution of Left Ventricular Thrombus in a Patient with Dilated Cardiomyopathy by Rivaroxaban

PT118 A study on Quality of life index in patients with prosthetic valve

Left ventricular (LV) thrombus formation is a feared complication of myocardial infarction (MI). We assessed the prevalence of LV thrombus in ST-segment elevated MI patients treated with percutaneous coronary intervention (PCI) and compared the diagnostic accuracy of transthoracic echocardiography (TTE) to cardiovascular magnetic resonance imaging (CMR). Also, we evaluated the course of LV thrombi in the modern era of primary PCI.200 patients with primary PCI underwent TTE and CMR, at baseline and at 4 months follow-up. Studies were analyzed by two blinded examiners. Patients were seen at 1, 4, 12, and 24 months for assessment of clinical status and adverse events.On CMR at baseline, a thrombus was found in 17 of 194 (8.8%) patients. LV thrombus resolution occurred in 15 patients. Two patients had persistence of LV thrombus on follow-up CMR. On CMR at four months, a thrombus was found in an additional 12 patients. In multivariate analysis, thrombus formation on baseline CMR was independently associated with, baseline infarct size (g) (B = 0.02, SE = 0.02, p < 0.001). Routine TTE had a sensitivity of 21–24% and a specificity of 95–98% compared to CMR for the detection of LV thrombi. Intra- and interobserver variation for detection of LV thrombus were lower for CMR (κ = 0.91 and κ = 0.96) compared to TTE (κ = 0.74 and κ = 0.53).LV thrombus still occurs in a substantial amount of patients after PCI-treated MI, especially in larger infarct sizes. Routine TTE had a low sensitivity for the detection of LV thrombi and the interobserver variation of TTE was large.

Rapid Resolution of Large Mobile Left Ventricular Thrombus with Anticoagulation in Dilated Cardiomyopathy: A Case Report

Development of left ventricular thrombus is a dreaded complication after myocardial infarction and in dilated cardiomyopathy. Early detection and treatment is important as it carries the risk of systemic embolism. Thrombolytic therapy, anticoagulation and surgical removals are considered treatment options in patient with left ventricular thrombus. Resolution of left ventricular thrombus with anticoagulation demonstrate the effectiveness of such therapy in preventing the dreaded complications of clot embolism.

A case of chronic left ventricular thrombus with ischemic cardiomyopathy

Left ventricular (LV) thrombus is a serious complication of anterior wall myocardial infarction (MI), especially in patients with severe LV dysfunction. LV thrombus carries a high risk of causing stroke and other thromboembolic complications despite adequate anticoagulation therapy. There is a benefit of anticoagulation in patients with ischemic cardiomyopathy to reduce thromboembolic events or in resolution of LV thrombus. Two-dimensional (2D) echocardiography is the most commonly used technique for the diagnosis and follow-up of such cases. Our patient developed a chronic LV thrombus with ischemic cardiomyopathy post anterior wall MI and was managed well on anticoagulants to prevent the thromboembolic events under strict vigilance and follow-up.

Resolution of left ventricular thrombus with lepirudin after failed treatment with heparin

A 49-year-old man was admitted with high-risk left ventricular thrombosis and systemic embolization. Prompt and complete resolution of the thrombus was achieved under intravenous lepirudin administration but not under full-dose heparin treatment. Medical physicians, including emergency medicine physicians, cardiologists, cardiac surgeons, and hematologists, should become more aware of these alternative anticoagulant treatments, especially in cases when other therapeutic options (such as thrombolysis or cardiac surgery) may be associated with high morbidity or mortality.

A Case Report of Carbon Monoxide Poisoning Induced Cardiomyopathy Complicated with Left Ventricular Thrombus

The heart and the brain, most oxygen-dependent organs, may be severely affected after carbon monoxide (CO) exposure. CO induced cardiotoxicity may occur as a consequence of moderate to severe CO poisoning, including angina attack, myocardial infarct, arrhythmias, and heart failure. We present a rare case of CO poisoning induced cardiomyopathy with left ventricular (LV) thrombus. It is thought that LV thrombus may have been caused severely decreased LV function with dyskinesis. After short-term anticoagulant therapy, echocardiography findings revealed complete recovery of LV dyskinesis and resolution of LV thrombus.

Effect of low dose acetylsalicylic acid on the frequency and hematologic activity of left ventricular thrombus in anterior wall acute myocardial infarction

In this prospective, randomized, placebo-controlled trial the effect of 100 mg acetylsalicylic acid (ASA) once daily on the incidence, hematologic activity and embolic potential of left ventricular (LV) thrombosis was studied in 100 consecutive patients with a first anterior wall acute myocardial infarction (AMI). Patients were randomized to ASA or placebo <12 hours after onset of symptoms. Heparin, 5,000 IU subcutaneously twice daily, was given to all patients during immobilization. Echocardiography was performed <24 hours, 48 to 72 hours and 1, 2, and 12 weeks after AMI. LV thrombosis was detected by echocardiography in 30 (33%) of the 92 evaluable patients (15 patients given ASA and 15 given placebo). Indium-111 platelet scintigraphy was done in 17 of the 22 patients with an LV thrombus at the second week echocardiogram. Among 7 ASA-treated patients, 4 had positive images; among 10 placebo patients, 5 had positive images. LV thrombus resolution was noted in 3 of 9 patients with a positive scan and in 5 of 8 patients with a negative platelet scan. In 7 of 10 ASA-treated patients and 5 of 12 placebo-treated patients thrombus resolution was observed (difference not significant). Systemic embolism occurred in 2 patients, both given ASA, during the first week after AMI. Thus, low dose ASA has no effect on the incidence, hematologic activity and embolic potential of LV thrombosis in anterior wall AMI.