Left ventricular thrombus

Left ventricular thrombus
Blood clots in the ventricle found on autopsy

Left ventricular thrombus is a blood clot (

LVT occurs most often during the first 2 weeks following AMI.[1] AMI patients most at risk display the 3 characteristics of Virchow's triad:^[1]

Stagnation of blood

The risk of LVT formation increases as infarction size increases.^[5] A larger infarction means a larger area of tissue injury, which may be akinetic or dyskinetic, resulting in stagnation of ventricular blood.^[1]

Endothelial injury

For several days after AMI, the levels of tissue factor and D-dimer, which are involved in coagulation, are high, which increases the risk of LVT formation.^[7] LVT may be good for the heart when tissues are severely damaged because it acts to thicken the wall, thus protecting it against rupture.^[1]

Diagnosis

• Thrombus of the left ventricle resulting in embolism of the spleen[9]
• Thrombus of the left ventricle resulting in embolism of the spleen^[9]
• Thrombus of the left ventricle resulting in embolism of the spleen^[9]
• 
  Thrombus of the left ventricle resulting in embolism of the spleen^[9]

Prevention

After an AMI, people should be treated to prevent LVT formation. Aspirin plus an oral anticoagulant such as warfarin are suggested for individuals at risk for thromboembolic events.^[10] Anticoagulants are also shown to reduce the risk of embolisms^[1][4] when a thrombus is already formed. Heparin, an injectable, fast-acting anticoagulant, is effective in high doses for preventing LVT formation after AMI.^[1][11]

Treatment

Systemic anticoagulation is considered first-line medical therapy for LVT, as it reduces the risk of systemic embolism.^[12][10] There are also surgical procedures for removal of a thrombus (thrombectomy).

Epidemiology

The rate of LVT formation after AMI is thought to be declining^[13][14] due to the use of better therapies and percutaneous coronary intervention used to treat myocardial infarction.^{[1][5][7][15]} In the modern era LVT formation after ST elevation MI treated with percutaneous coronary intervention is low, estimated at only 2.7%.^[16] However, incidence of LVT is considered higher in anterior wall AMI, compared with other types.^[17]

References