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- Academic Editors
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†These authors contributed equally.
Background: Recommendations for drug treatment of left ventricular
thrombus (LVT) are based on the ST-segment elevation myocardial infarction
(STEMI) guidelines; however, the etiology of LVT has changed. Due to the lack of
evidence regarding LVT treatment in the heart failure population, current heart
failure guidelines do not cover LVT treatment. We sought to
review the etiology of LVT and changes in antithrombotic therapy over the
previous 12 years and explore the impact of anticoagulation treatment from a
single center’s experience. Methods: From January 2009 to June 2021, we
studied 1675 patients with a discharge diagnosis of LVT at a single center to
investigate the clinical characteristics, incidence of all-cause death,
cardiovascular death, ischemic stroke, major adverse cardiac and cerebrovascular
events (MACCE), systemic embolism (SE), and major bleeding events. Patients were
divided into an anticoagulant group and a non-anticoagulant group according to
whether they received oral anticoagulant therapy at discharge. Results:
The study included 909 patients (anticoagulation, 510; no anticoagulation, 399).
While overall antiplatelet therapy dramatically decreased, more patients with LVT
received oral anticoagulation in 2021 (74.0%) than in 2009 (29.6%). In
addition, more than half of the patients had heart failure with reduced ejection
fraction (HFrEF) each year. The all-cause mortality was 17.3% during 3.8 years
of follow-up. The incidences of cardiovascular death, stroke, MACCE, SE, and
major bleeding were 16.0%, 3.3%, 19.8%, 5.1%, and 1.7%, respectively. The
anticoagulation group had a significantly higher proportion of dilated
cardiomyopathy than the non-anticoagulation group (24.7% vs. 5.5%, p