Anticoagulation for Left Ventricle Thrombus—Case Series and Literature Review for Use of Direct Oral Anticoagulants
Left ventricular thrombus is a known complication following acute myocardial infarction that can lead to systemic thromboembolism. To obviate the risk of thromboembolism, the patient needs anticoagulation in addition to dual antiplatelet therapy. However, combining antiplatelets with anticoagulants...
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MDPI AG
2023-01-01
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| Series: | Journal of Cardiovascular Development and Disease |
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| Online Access: | https://www.mdpi.com/2308-3425/10/2/41 |
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| author | Akshyaya Pradhan Monika Bhandari Pravesh Vishwakarma Chiara Salimei Ferdinando Iellamo Rishi Sethi Marco Alfonso Perrone |
| author_facet | Akshyaya Pradhan Monika Bhandari Pravesh Vishwakarma Chiara Salimei Ferdinando Iellamo Rishi Sethi Marco Alfonso Perrone |
| author_sort | Akshyaya Pradhan |
| collection | DOAJ |
| description | Left ventricular thrombus is a known complication following acute myocardial infarction that can lead to systemic thromboembolism. To obviate the risk of thromboembolism, the patient needs anticoagulation in addition to dual antiplatelet therapy. However, combining antiplatelets with anticoagulants substantially increases the bleeding risk. Traditionally, vitamin K antagonists (VKAs) have been the sheet anchor for anticoagulation in this scenario. The use of direct oral anticoagulants has significantly attenuated the bleeding risk associated with anticoagulation for atrial fibrillation and venous thromboembolism. Furthermore, in patients with atrial fibrillation undergoing percutaneous coronary intervention, the use of direct oral anticoagulants (DOACs) in conjunction with antiplatelets has been found to be noninferior in reducing ischemic events while significantly attenuating the bleeding compared with VKA. After initial case reports, multiple observational and nonrandomized studies have now safely and effectively utilized direct oral anticoagulants for anticoagulation in left ventricular thrombus. Here, we report a series of two cases presenting with left ventricular thrombus following acute myocardial infarction. In this case series, we try to address the issues concerning the choice and duration of anticoagulation in the case of postinfarct left ventricular thrombus. Pending the results of large randomized control trials, the judicious use of direct oral anticoagulant is warranted when taking into consideration the ischemic and bleeding profile in an individualized approach. |
| first_indexed | 2024-03-11T08:38:44Z |
| format | Article |
| id | doaj.art-72382ef6b86841028fdb8dcd8ae280fc |
| institution | Directory Open Access Journal |
| issn | 2308-3425 |
| language | English |
| last_indexed | 2024-03-11T08:38:44Z |
| publishDate | 2023-01-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Cardiovascular Development and Disease |
| spelling | doaj.art-72382ef6b86841028fdb8dcd8ae280fc2023-11-16T21:16:12ZengMDPI AGJournal of Cardiovascular Development and Disease2308-34252023-01-011024110.3390/jcdd10020041Anticoagulation for Left Ventricle Thrombus—Case Series and Literature Review for Use of Direct Oral AnticoagulantsAkshyaya Pradhan0Monika Bhandari1Pravesh Vishwakarma2Chiara Salimei3Ferdinando Iellamo4Rishi Sethi5Marco Alfonso Perrone6Department of Cardiology, King George’s Medical University, Lucknow 226003, IndiaDepartment of Cardiology, King George’s Medical University, Lucknow 226003, IndiaDepartment of Cardiology, King George’s Medical University, Lucknow 226003, IndiaDepartment of Cardiology and CardioLab, University of Rome Tor Vergata, 00133 Rome, ItalyDepartment of Cardiology and CardioLab, University of Rome Tor Vergata, 00133 Rome, ItalyDepartment of Cardiology, King George’s Medical University, Lucknow 226003, IndiaDepartment of Cardiology and CardioLab, University of Rome Tor Vergata, 00133 Rome, ItalyLeft ventricular thrombus is a known complication following acute myocardial infarction that can lead to systemic thromboembolism. To obviate the risk of thromboembolism, the patient needs anticoagulation in addition to dual antiplatelet therapy. However, combining antiplatelets with anticoagulants substantially increases the bleeding risk. Traditionally, vitamin K antagonists (VKAs) have been the sheet anchor for anticoagulation in this scenario. The use of direct oral anticoagulants has significantly attenuated the bleeding risk associated with anticoagulation for atrial fibrillation and venous thromboembolism. Furthermore, in patients with atrial fibrillation undergoing percutaneous coronary intervention, the use of direct oral anticoagulants (DOACs) in conjunction with antiplatelets has been found to be noninferior in reducing ischemic events while significantly attenuating the bleeding compared with VKA. After initial case reports, multiple observational and nonrandomized studies have now safely and effectively utilized direct oral anticoagulants for anticoagulation in left ventricular thrombus. Here, we report a series of two cases presenting with left ventricular thrombus following acute myocardial infarction. In this case series, we try to address the issues concerning the choice and duration of anticoagulation in the case of postinfarct left ventricular thrombus. Pending the results of large randomized control trials, the judicious use of direct oral anticoagulant is warranted when taking into consideration the ischemic and bleeding profile in an individualized approach.https://www.mdpi.com/2308-3425/10/2/41left ventricular thrombusanticoagulationanterior wall myocardial infarctiondual therapydirect oral anticoagulants |
| spellingShingle | Akshyaya Pradhan Monika Bhandari Pravesh Vishwakarma Chiara Salimei Ferdinando Iellamo Rishi Sethi Marco Alfonso Perrone Anticoagulation for Left Ventricle Thrombus—Case Series and Literature Review for Use of Direct Oral Anticoagulants Journal of Cardiovascular Development and Disease left ventricular thrombus anticoagulation anterior wall myocardial infarction dual therapy direct oral anticoagulants |
| title | Anticoagulation for Left Ventricle Thrombus—Case Series and Literature Review for Use of Direct Oral Anticoagulants |
| title_full | Anticoagulation for Left Ventricle Thrombus—Case Series and Literature Review for Use of Direct Oral Anticoagulants |
| title_fullStr | Anticoagulation for Left Ventricle Thrombus—Case Series and Literature Review for Use of Direct Oral Anticoagulants |
| title_full_unstemmed | Anticoagulation for Left Ventricle Thrombus—Case Series and Literature Review for Use of Direct Oral Anticoagulants |
| title_short | Anticoagulation for Left Ventricle Thrombus—Case Series and Literature Review for Use of Direct Oral Anticoagulants |
| title_sort | anticoagulation for left ventricle thrombus case series and literature review for use of direct oral anticoagulants |
| topic | left ventricular thrombus anticoagulation anterior wall myocardial infarction dual therapy direct oral anticoagulants |
| url | https://www.mdpi.com/2308-3425/10/2/41 |
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