A Case Report of Laminated Left Ventricular Thrombus in Acute Decompensated Heart Failure: Pharmacotherapeutic Considerations for Anticoagulation

Left ventricular (LV) thrombus is a known complication of severe systolic dysfunction and is associated with an increased risk of systemic embolization. Optimal pharmacotherapeutic management remains an area of clinical uncertainty, particularly when thrombus morphology suggests lower embolic potential. A 56-year-old man with multiple cardiovascular risk factors presented with progressive dyspnea, anasarca, and hypoxic respiratory failure. Cardiac imaging demonstrated severe biventricular dysfunction (ejection fraction <20%) and a large, laminated, nonmobile apical LV thrombus. Concurrent findings included congestive hepatopathy with ascites and a small pulmonary embolism. Based on thrombus morphology and clinical stability, systemic anticoagulation was initiated without invasive intervention. The patient improved with aggressive diuresis, guideline-directed medical therapy for heart failure, and therapeutic anticoagulation. This case highlights pharmacotherapeutic considerations in the management of laminated LV thrombus, including the role of thrombus morphology in risk stratification, anticoagulant selection, and timing of therapy initiation. Early recognition and coordinated interdisciplinary management can support safe, noninvasive treatment strategies in complex heart failure presentations. In addition, this case highlights the importance of collaborative practice and pharmacist-guided anticoagulation strategies.