[Managing patients with left ventricular thrombosis after acute myocardial infarction: current evidence, uncertainties, and future perspectives]. in Giornale italiano di cardiologia (2006) / G Ital Cardiol (Rome). 2023 Mar;24(3):196-205. doi: 10.1714/3980.39622.
2023
AO Cuneo
Tipo pubblicazione
Journal Article
Autori/Collaboratori (8)Vedi tutti...
Giordana F
U.O.C. Cardiologia, Azienda Ospedaliera Santa Croce e Carle, Cuneo.
Bugani G
U.O.C. Cardiologia, Ospedale Maggiore, Bologna.
Camilli M
Dipartimento di Scienze Cardiovascolari e Pneumologiche, Università Cattolica del Sacro Cuore, Roma - Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma.
et alii...
Abstract
The incidence of left ventricular thrombosis (LVT) after acute myocardial infarction has declined significantly in recent decades, thanks to advances in the field of revascularization and antithrombotic therapy. Despite oral anticoagulation, embolic events are the most feared complication of LVT. From a pathophysiological point of view, the development of LVT depends on Virchow's triad, that is, endothelial damage caused by myocardial infarction, blood stasis due to left ventricular dysfunction, and hyper-coagulability determined by inflammation. The diagnostic modalities of LVT include transthoracic echocardiography preferably implemented by contrast administration, and cardiac magnetic resonance. Most thrombi develop in the first 2 weeks after acute myocardial infarction, so the role of systematic screening with short to medium term repeated imaging appears limited. Vitamin K antagonists remain the cornerstone of therapy, since the effectiveness of direct oral anticoagulants remains to be established. Only weak evidence supports the routine use of prophylactic anticoagulant therapy, even in high-risk patients.
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PMID : 36853156
DOI : 10.1714/3980.39622
Keywords
Myocardial Infarction/complications; Humans; Anticoagulants/therapeutic use; Heart; Thrombosis/etiology/prevention & control; Heart Ventricles/diagnostic imaging; Heart Diseases;