Treatment of left ventricular thrombus after myocardial infarction: need longer or lifetime use of anticoagulants?

Currently, extensive anterior MI, LV ejection fraction less than 40%, severe regional wall motion abnormalities, and left ventricular aneurysm are considered to be independent risk factors for LVT. 2 For patients with confirmed LVT, current guidelines recommend starting anticoagulant plus antiplatelet therapy for 3–6 months; if there is evidence of LVT resolution, oral anticoagulants can be discontinued. 3,4 In terms of anticoagulant selection, the latest meta-analysis showed that there was no significant difference between direct oral anticoagulants (DOACs) and VKA in the efficacy of LVT resolution (P = 0.22), but the DOACs group had a lower risk of bleeding. 5 However, in clinical practice, we found that many patients encountered LVT recurrence after anticoagulants discontinuation (a typical case will be enclosed with the letter). [...]after finding that 53% of systemic embolism events occurred after 6 months of AMI onset, Maniwa et al. suggested that a longer (over 6 months) anticoagulation therapy should be required for prevention of systemic embolism in MI patients with LVT. 8 Although long-term anticoagulation therapy may benefit those patients, it is worth noting that the implementation of anticoagulation therapy should be individualized and evaluated according to the risk stratification and anticoagulant tolerance. A typical case: a 56-year-old male patient was admitted to hospital in August, 2015, complaining of chest tightness and shortness of breath for 1 month.