Echocardiographic features, antithrombotic therapy, and association with outcomes in patients with left ventricular thrombus after myocardial infarction: a single-center retrospective study

Abstract Introduction and aim Left ventricular thrombus (LVT) is a rare but threatening complication after acute myocardial infarction (MI). Guidelines recommend oral anticoagulation for at least 3–6 months. This retrospective, single-center cohort study describes the incidence of LVT, the antithrombotic regimen, and the association with LVT regression and clinical outcomes. Methods Patients admitted between January 1st, 2008, and December 31st, 2022, with MI were screened for the presence of LVT. Primary outcomes were the incidence of LVT, secular trends of oral anticoagulation prescription at discharge (direct oral anticoagulants vs Vitamin-K-antagonists), and change of LVT size or complete regression at follow-up examination. Secondary outcomes were all-cause death, embolic events associated with the LVT diagnosis, and bleeding events (BARC ≥ 2). Results A total of 19,964 patients admitted with MI between 2008 and 2022 were identified, of whom 166 (0.83%) had a confirmed LVT. Eighty-five patients were prescribed a VKA, 49 patients a DOAC, and 26 patients another form of anticoagulation. Transthoracic echocardiography follow-up was available for 120 patients, of whom 95 (79%) showed complete thrombus resolution. No statistically significant difference in complete thrombus resolution was detected between DOAC and VKA groups (87% vs. 79%; p = 0.42). Thirty-eight clinical events (bleeding, all-cause death, and embolic events) occurred within 12 months after LVT diagnosis without significant differences between DOAC and VKA. Conclusion DOAC use increased over time, with no statistically significant difference in early complete thrombus resolution or clinical events compared with VKA.