Table 2. Clinical studies in prevention and treatment of LVT.
| Author, year (reference) | Type of study [number of patients] | Conclusion |
|---|---|---|
| Arvan, 1987 (77) | RCT [30] | No difference in LVT incidence after acute anterior MI with the use of heparin infusion, partial thromboplastin time >60 seconds |
| Tavazzi, 1989 (78) | RCT [711] | After acute anterior MI, 12,500 U of subcutaneous heparin reduced LVT incidence and mortality |
| Turpie, 1989 (79) | RCT [183] | In patients with acute anterior MI subcutaneous heparin at a dose of 12,500 U BID was more effective preventing LVT than 5,000 units BID |
| Kouvaras, 1990 (80) | Prospective [60] | High-dose aspirin was noninferior to warfarin for LVT resolution after 3 months |
| Kontny, 1993 (81) | Prospective [229] | High-dose heparin prevented LVT irrespective of warfarin therapy after acute anterior MI. Warfarin therapy without heparin was associated with higher rates of LVT |
| Kontny, 1997 (82) | RCT [517] | Dalteparin 150 IU/kg BID significantly reduces LVT after acute anterior MI (RR: 0.63, 95% CI: 0.43–0.92, P=0.02) but is associated with increased hemorrhagic risk. |
| Meurin, 2005 (83) | Prospective [19] | Enoxaparin BID followed by fluindione was as effective as unfractionated heparin at 3 weeks |
| Le May, 2015 (84) | Retrospective [460] | In patients with apical akinesis or dyskinesis, prophylactic use of warfarin increases net adverse events (all-cause mortality, strokes, reinfarction and major bleeding) |
| White, 2015 (85) | RCT [60] | Enoxaparin for 30 days post MI shortened hospitalization and lowered cost of care compared to warfarin, with no statistical difference among the groups of LVT at 3 months |
| Smetana, 2017 (86) | Case series [10] | Patients with LVT treated with rivaroxaban and apixaban showed complete thrombus resolution in 8 patients, with only one bleeding event |
| Robinson, 2018 (87) | Retrospective [98] | DOAC-treated patients (mostly apixaban) had similar SSE-free survival |
| Maniwa, 2018 (65) | Retrospective [2,301] | In patients with LVT treated with VKA, the time in therapeutic range >50% was associated with lower embolic events without increasing bleeding events |
| Altýntaþ, 2019 (88) | Retrospective [641] | After STEMI, ticagrelor use had lower incidence of LVT than clopidogrel, OR: 0.53, 95% CI: 0.28–0.96, P=0.039 |
| Daher, 2020 (89) | Retrospective [59] | Similar efficacy between DOAC and VKA agents in patients with LVT (70.6% vs. 71.5%) |
| Lattuca, 2020 (74) | Retrospective [159] | Anticoagulation therapy >3 months was independently associated with less MACE (HR: 0.42; 95% CI: 0.20–0.88; P=0.021). Reduced risk of mortality was observed among patients with total LVT regression (15.2% vs. 25.0%; HR: 0.48; P=0.039), with higher bleeding rates |
| Robinson, 2020 (73) | Retrospective [514] | Anticoagulation with DOAC vs. warfarin had higher rates of SSE (adjusted HR: 2.64, 95% CI: 1.28–5.43, P=0.01) |
| Guddeti, 2020 (90) | Retrospective [99] | Resolution of LVT, rates of stroke and bleeding were not statistically different between VKA and DOAC |
| Iqbal, 2020 (91) | Retrospective [84] | No statistically significant differences between VKA and DOAC in rates of LVT resolution (76% vs. 65%), SSE (2% vs. 0%), or clinically significant bleeding (10% vs. 0%) |
| Ali, 2020 (92) | Retrospective [110] | Treatment with DOACs was associated with lower 1-year risk of stroke (12% vs. 6%, P=0.33), although no difference found in ischemic stroke or thrombus resolution) |
BID, every 12 hours; DOAC, direct oral anticoagulant; LVT, left ventricular thrombus; MACE, major adverse cardiovascular event; MI, myocardial infarction; NSTEMI, non-ST elevation myocardial infarction; RCT, randomized clinical trial; SSE, stroke or systemic embolism; STEMI, ST elevation myocardial infarction; VKA, vitamin K antagonist.