Incidence and Predictors of Thromboembolic Events after Anticoagulant Therapy in Patients with Left Ventricular Thrombus

Background: Left ventricular thrombus (LVT) occurs in patients with LV dysfunction and is associated with increased thromboembolic risk. The management of LVT is important clinical issue that we encounter in daily practice. However, data regarding the incidence of thromboembolism and its predictive factors are limited. Methods: We retrospectively investigated 57 consecutive patients (mean age, 63 ± 15years; mean EF, 43 ± 16%) who showed LVT and were treated with anticoagulant therapy. The incidence of thromboembolism was examined, and the etiologies of LV dysfunction, clinical factors and transthoracic echocardiographic parameters were evaluated. The size and morphology of LVT were also examined with echocardiography. Results: The etiologies of LV dysfunction were ischemic cardiomyopathy in 37 patients, dilated cardiomyopathy in 7, hypertrophic cardiomyopathy in 6, stress-induced cardiomyopathy in 5, and others in 2. Thromboembolism occurred in 8 (14%) at a median of 8 days after anticoagulant therapy (stroke, 6; others, 2). Among 49 patients without thromboembolism, LVT decreased in size in 46, and was unchanged in 3. Protruding or mobile thrombus were significantly related to thromboembolism, while the size was not. The incidence of ischemic cardiomyopathy was also higher in patients with thromboembolism than those without. Conclusions: In patients with LVT, the incidence of thromboembolism after anticoagulant therapy was unexpectedly high (14%). Preventive thrombectomy may be considered in patient with protruding and/or mobile LVT.