From the Guidelines
Patients with a mural thrombus on a CAT scan should be anticoagulated with a vitamin K antagonist (VKA) such as warfarin, with a goal INR of 2.0 to 3.0, for at least 3 months to reduce the risk of stroke or systemic embolism. This recommendation is based on the 2021 guideline for the prevention of stroke in patients with stroke and transient ischemic attack from the American Heart Association/American Stroke Association 1. The use of VKA has been shown to reduce the risk of stroke by 86% and result in resolution of left ventricular (LV) thrombus in 68% of patients 1.
Key Considerations
- The risk of stroke or systemic embolism in the presence of LV thrombus is significantly reduced with anticoagulation therapy 1.
- The exact time for each thrombus to mature and reduce the risk of embolism is unknown, but the risk is reduced after 3 months 1.
- Cardiac MRI is a superior imaging modality for detecting LV thrombus compared to standard transthoracic echocardiography 1.
- Patients with reduced LV systolic function (LV EF <50%) in the setting of acute anterior MI are at the greatest risk of developing LV thrombus 1.
Treatment Approach
- Anticoagulation therapy should be initiated as soon as possible after diagnosis of a mural thrombus 1.
- The choice of anticoagulant and duration of therapy should be individualized based on patient factors and the underlying cause of the thrombus 1.
- Regular follow-up imaging is recommended to monitor the resolution of the thrombus and adjust treatment accordingly 1.
Important Notes
- Direct oral anticoagulants (DOACs) such as apixaban, rivaroxaban, or dabigatran may be considered as an alternative to VKA, but the evidence is limited and the risk of bleeding and embolic events should be carefully weighed 1.
- Treating the underlying cause of the thrombus, such as managing heart failure or controlling hypertension, is crucial to prevent recurrence 1.
From the Research
Mural Thrombus on CAT Scan
- A mural thrombus is a blood clot that forms in a blood vessel, and it can be detected on a CAT scan 2, 3.
- The presence of a mural thrombus can increase the risk of embolism, which can lead to serious health complications such as stroke or organ damage 4, 5.
- Treatment for mural thrombus typically involves anticoagulation therapy to prevent further clotting and reduce the risk of embolism 6, 2, 3.
- In some cases, surgical intervention may be necessary to remove the thrombus or repair damaged blood vessels 2, 3.
- The use of imaging techniques such as CAT scans and echocardiography can help diagnose and monitor mural thrombus formation 2, 4, 3.
- Risk factors for developing a mural thrombus include a history of deep vein thrombosis, malignancy, and thrombophilia 5.
- The management of inferior vena cava thrombosis, a type of mural thrombus, may involve anticoagulation, catheter-directed thrombolysis, mechanical thrombectomy, or stenting 5.