A single-center retrospective analysis of more than 100,000 echocardiograms found a relatively low incidence of left ventricular (LV) thrombus, with a higher risk in those with de novo heart failure (HF), acute myocardial infarction (MI) and incomplete guideline-directed medical therapy regimens (GDMT), according to a study published March 4 in the Journal of the American College of Cardiology which will be presented during ACC.19 in New Orleans, LA.

Cian McCarthy, MB, BCh, BAO, et al., evaluated etiologies, treatment strategies, follow-up imaging and one-year outcomes in 140,636 echocardiograms performed over seven years, identifying 128 incidences of LV thrombus. The most common precipitating factor was HF (68.5 percent), 38 percent of which were de novo diagnoses and 86 percent of which had ejection fraction of 40 percent or less. Use of GDMT was low at the time of diagnosis.

The second most common precipitating factor was acute MI (25.9 percent), the majority of which were STEMI (71 percent). The authors also found that LV thrombus most commonly occurred in the left anterior descending artery (77.8 percent), with a high prevalence of global LV dysfunction (64.8 percent).

In addition, the majority of patients with LV thrombus received bridging anticoagulation (primarily warfarin) upon discharge, with 43 percent of MI patients discharged on dual antithrombotic therapy and 54 percent on triple regimens.

Over the one-year follow-up, 13 percent of patients died (none due to bleeding), 1.9 percent experienced strokes and 2.8 percent nonfatal bleeding. Among those with follow-up imaging within 1-year (64.8 percent), thrombus resolution occurred in 75 percent of those who received warfarin, 40 percent who received low molecular weight heparin and 100 percent who received direct oral anticoagulants. Among the 67 patients with available data on the duration of anticoagulation, 59.7 percent received indefinite therapy and 40.3 percent received treatment for varying durations (median 6 months).

The authors conclude that the relatively low incidence of LV thrombus may explain why routine strategies of prophylactic anticoagulation in HF have not proven beneficial.

Clinical Topics: Anticoagulation Management, Heart Failure and Cardiomyopathies, Noninvasive Imaging, Acute Heart Failure, Echocardiography/Ultrasound

Keywords: ACC19, ACC Annual Scientific Session, Warfarin, Incidence, Heparin, Low-Molecular-Weight, Fibrinolytic Agents, Precipitating Factors, Retrospective Studies, Stroke Volume, Thrombosis, Anticoagulants, Stroke, Echocardiography, Heart Failure, Arteries

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