Left Ventricular Thrombus Following Acute Myocardial Infarction: JACC State-of-the-Art Review.

The incidence of left ventricular (LV) thrombus following acute myocardial infarction has markedly declined in recent decades caused by advancements in reperfusion and antithrombotic therapies. Despite this, embolic events remain the most feared complication of LV thrombus necessitating systemic anticoagulation. Mechanistically, LV thrombus development depends on Virchow's triad (ie, endothelial injury from myocardial infarction, blood stasis from LV dysfunction, and hypercoagulability triggered by inflammation, with each of these elements representing potential therapeutic targets). Diagnostic modalities include transthoracic echocardiography with or without ultrasound-enhancing agents and cardiac magnetic resonance. Most LV thrombi develop within the first 2 weeks post-acute myocardial infarction, and the role of surveillance imaging appears limited. Vitamin K antagonists remain the mainstay of therapy because the efficacy of direct oral anticoagulants is less well established. Only meager data support the routine use of prophylactic anticoagulation, even in high-risk patients.

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Funding Support and Author Disclosures Dr Giustino has received honoraria from Bristol Myers Squibb. Dr Halperin has performed consulting activities with Bayer HealthCare, Boehringer Ingelheim, and Ortho-McNeil-Janssen; and has served on the Steering Committee of the CATALYST trial, sponsored by Abbott. Dr Sharma has received consulting fees or honoraria from Abbott, Boston Scientific, Abiomed, and Cardiovascular Systems, Inc. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.