Current insights and challenges in the management of left ventricular thrombus.

Abstract

Left ventricular thrombus is a relatively common and serious complication in patients with left ventricular systolic dysfunction, resulting in an increased risk of embolic events such as ischemic stroke and contributing to higher mortality rates. Current clinical guidelines recommend anticoagulation therapy for 3 to 6 months in patients with left ventricular thrombus; however, the evidence supporting this approach primarily derives from small-scale randomized trials or retrospective observation studies, which limit the generalizability of findings across diverse patient populations. Several critical aspects of left ventricular thrombus identification and management remain inadequately studied, and these areas include optimal time and detection imaging methods, anticoagulation strategies (treatment of choice and optimal duration), and the need for periodic re-evaluation. This review consolidates the current evidence, identifies gaps in left ventricular thrombus management, and proposes individualized strategies that consider factors like left ventricular function and bleeding risks.