What is the rate of embolization in left ventricular thrombus (Left Ventricular Thrombus) without anticoagulation therapy?

From the Guidelines

The rate of embolization in left ventricular thrombus without anticoagulation therapy is approximately 10%. Patients with left ventricular thrombus who do not receive anticoagulation therapy face a significant risk of systemic embolization, particularly stroke. This risk is highlighted in the guidelines for the prevention of stroke in patients with stroke or transient ischemic attack, which notes that clinically evident cerebral infarction occurs in approximately 10% of patients with LV thrombus following MI, in the absence of anticoagulant therapy 1.

Key Points

• The risk of embolization is significant, with approximately 10% of patients with left ventricular thrombus experiencing clinically evident cerebral infarction without anticoagulation therapy.
• Anticoagulation therapy, such as warfarin, can reduce the occurrence of cerebral embolism by more than 50% compared to no anticoagulation, as demonstrated in large trials involving patients with acute inferior and anterior MIs 1.
• The duration of anticoagulant treatment is not well established, but the risk of thromboembolism seems to decrease after the first 3 months.
• The pathophysiology involves thrombus fragmentation and dislodgement into the systemic circulation, facilitated by left ventricular contraction.

Clinical Implications

• Anticoagulation therapy is strongly recommended for patients with left ventricular thrombus to reduce the risk of embolization.
• The decision to initiate anticoagulation therapy should be individualized, taking into account the patient's risk of thromboembolism and bleeding.
• Close monitoring of patients with left ventricular thrombus is essential to detect any changes in thrombus characteristics or signs of embolization.

From the Research

Left Ventricular Thrombus Embolization Rate Without Anticoagulation Therapy

• The provided studies do not directly report the rate of embolization in left ventricular thrombus (LVT) without anticoagulation therapy 2, 3, 4, 5, 6.
• However, the studies suggest that anticoagulation therapy is effective in reducing the rate of thrombus formation and embolic phenomena in patients with LVT 2, 3, 5, 6.
• A study found that the use of direct oral anticoagulants (DOACs) was associated with reduced mortality and bleeding compared to warfarin, but there was a nonsignificant reduction in stroke/embolic events 2.
• Another study reported that therapeutic anticoagulation during acute myocardial infarction reduces the incidence of LVT, and long-term anticoagulation has been associated with a reduction in recurrent infarction and ischemic stroke 3.
• The rate of stroke/embolic events in patients with LVT who received any treatment was reported to be 6.4% at follow-up of up to 12 months 2.
• However, the rate of embolization in LVT without anticoagulation therapy is not explicitly stated in the provided studies.

Treatment and Outcomes of Left Ventricular Thrombus

• The standard of care for LVT is anticoagulation with warfarin, but non-vitamin K antagonist oral anticoagulants (NOACs) are being increasingly used for the treatment of LVT 5, 6.
• A meta-summary of case reports found that the use of NOACs in patients with LVT was associated with a high rate of thrombus resolution (87.9%) and a low rate of bleeding and embolic events 5.
• A systematic review of the literature found that the use of DOACs in the treatment of LVT was associated with a high rate of thrombus resolution (81-100%) and a low rate of bleeding and thromboembolic events 6.