Left Ventricular Thrombus and the Practicalities: An Audit of Short- to Mid-Term Follow-Up of Resolution and Complications.

Abstract

Background: Left ventricular (LV) thrombus is often seen in patients with severe LV dysfunction, particularly severe LV apical hypokinesis or akinesis of any aetiology. Embolisation of thrombus is associated with significant morbidity and mortality, and current guidelines recommend an initial three- to six-month period of anticoagulation with warfarin to clear clot burden, accepting associated bleeding risk. Depending on aetiology of apical hypokinesis and improvement with heart failure therapy, long-term anticoagulation may or may not be considered. We report our own observational experience of a small cohort of patients with LV thrombus. Method(s): A retrospective observational cohort study of 15 patients with LV thrombus diagnosed between 01/02/20-01/02/24 was performed of patients at a single sub-tertiary centre in Melbourne, Victoria. Patients were followed up for an average of 30 months. Result(s): 15 patients with LV thrombus were followed up across the study period. 55% presented due to heart failure (HF), 36% following MI and 9% post-stroke. 91% of patients had resolution of LV thrombus following 6 months of warfarinsation. Median and average ejection fraction (EF) was 30% and 31.2%, respectively. No patients had identified thromboembolic events on review post-commencement of treatment or post-cessation. Similarly, no significant bleeding events were noted. Conclusion(s): Our data is reflective of previously reported resolution and complication rates, albeit within a relatively small patient cohort. This raises the question for future studies as to whether or not anticoagulation duration can be safely reduced in such comorbid patients, especially those with considerable major bleeding risk.Copyright � 2024