• Acute coronary syndrome
• Acute ischemic stroke
• Late reperfusion
• Left ventricle thrombus

• Humans
• Male
• ST Elevation Myocardial Infarction/complications
• ST Elevation Myocardial Infarction/therapy
• Middle Aged
• Thromboembolism/etiology
• Thromboembolism/therapy
• COVID-19
• Anticoagulants/therapeutic use
• Heart Ventricles/diagnostic imaging
• Thrombosis
• Percutaneous Coronary Intervention

• bleeding
• direct oral anticoagulants
• intraventricular thrombus
• systemic arterial embolism
• warfarin

• Takotsubo syndrome
• anticoagulation
• cardioembolic strokes
• magnetic resonance imaging
• ventricular thrombus

• Humans
• Female
• Takotsubo Cardiomyopathy/complications
• Takotsubo Cardiomyopathy/diagnostic imaging
• Aged, 80 and over
• Thrombosis/complications
• Thrombosis/diagnostic imaging
• Heart Ventricles/pathology
• Heart Ventricles/diagnostic imaging
• Embolic Stroke/etiology
• Embolic Stroke/complications
• Embolic Stroke/diagnostic imaging
• Magnetic Resonance Imaging
• Anticoagulants/therapeutic use

• direct oral anticoagulants
• left ventricular thrombus
• meta-analysis
• myocardial infarction
• vitamin K antagonists

• Humans
• Administration, Oral
• Anticoagulants/therapeutic use
• Factor Xa Inhibitors/therapeutic use
• Heart Diseases/etiology
• Heart Diseases/drug therapy
• Heart Diseases/complications
• Heart Ventricles
• Myocardial Infarction/complications
• Myocardial Infarction/drug therapy
• Thrombosis/etiology
• Thrombosis/drug therapy
• Vitamin K/antagonists & inhibitors

• DOAC
• LV thrombus
• VKA

• varfarina
• inibidores do fator xa
• trombose

• Humans
• Administration, Oral
• Anticoagulants/therapeutic use
• Heart Diseases/drug therapy
• Heart Ventricles/drug effects
• Hemorrhage/chemically induced
• Randomized Controlled Trials as Topic
• Stroke/drug therapy
• Thrombosis/drug therapy
• Treatment Outcome
• Vitamin K/antagonists & inhibitors

• Adenosine
• CMR
• Cardiovascular imaging
• Dobutamine
• LV thrombus
• Stroke

• Humans
• Male
• Dobutamine/adverse effects
• Adenosine
• Magnetic Resonance Imaging, Cine
• Retrospective Studies
• Magnetic Resonance Imaging
• Vasodilator Agents/adverse effects
• Thrombosis/diagnosis
• Thrombosis/etiology
• Thrombosis/pathology

• D.10021788 Deutsches Zentrum für Herz-Kreislaufforschung

• Anticoagulation
• Case report
• Congenital heart disease
• Direct oral anticoagulant
• Intracardiac thrombus
• Levo-transposition of the great arteries
• Systemic right ventricle

• anterior wall myocardial infarction
• anticoagulation
• direct oral anticoagulants
• dual therapy
• left ventricular thrombus

• AHA Scientific Statements
• anticoagulants
• thrombosis

• American Heart Association
• Anticoagulants/therapeutic use
• Heart Ventricles/diagnostic imaging
• Humans
• Platelet Aggregation Inhibitors/therapeutic use
• Thrombosis/diagnostic imaging
• Thrombosis/drug therapy
• Vitamin K/therapeutic use
• Warfarin/therapeutic use

Idiopathic hypereosinophilic syndrome (IHES) is a rare but life-threatening disease related to a group of myeloproliferative disorders characterized by prolonged eosinophilia of unknown cause and inflammatory damage to multiple organs. Here, we present a 44-year-old female patient complaining of shortness of breath and palpitations for 1 month. Her history and presentation were unremarkable, except for a 3-years history of rheumatoid arthritis treated with ibuprofen (0.3 g per day). Initial examination showed heart rate (HR) 120 bpm, respiratory rate (RR) 20 bpm, temperature (T) 36°C, blood pressure (BP) 130/70 mmHg, ventricular gallop rhythm, rales at the lung bases, soft abdomen, nonpalpable liver and spleen, and slight edema in both lower extremities. Bone marrow aspirate and biopsy confirmed the diagnosis of IHES, while cardiac MRI showed intracardiac thrombus. The symptoms of shortness of breath and palpitation disappeared, the eosinophil counts in routine blood tests were normal, and the thrombus in the cardiac cavity gradually disappeared after combined therapy of anti-hypereosinophilic, anti-coagulant and anti-heart failure treatments.

• National Natural Science Foundation of China

Anticoagulation with warfarin remains the mainstay treatment for left ventricular thrombi. Although successful thrombus resolution has been reported with direct oral anticoagulants' (DOACs') recurrence/progression while resuming Apixaban therapy is yet to be reported. Case Presentation. This case report describes left ventricular thrombus progression/recurrence in a patient anticoagulated with Apixaban undergoing implantable cardioverter defibrillator to cardiac resynchronisation therapy with defibrillator upgrade procedure. He was thereafter changed to warfarin. Contrast echocardiogram at 6 months follow-up did not identify the previously demonstrated mural thrombus.

Prospective randomised control trials should be conducted in patients with left ventricular thrombus to compare anticoagulants, assess the efficacy and safety of DOACs, and evaluate uninterrupted DOAC versus transient withdrawal for cardiac device procedures.

Noncompaction cardiomyopathy (NCC) is congenital cardiomyopathy characterized by trabeculations of the left ventricle found on echocardiogram and/or cardiac magnetic resonance imaging (CMRI). This rare disease is associated with thromboembolism and an increased risk of ventricular thrombus formation. We present the case of a 73-year-old female who was admitted for a suspected cerebrovascular accident (CVA), later found on echocardiogram and CMRI to have NCC with left ventricular thrombus. She was started on warfarin indefinitely. We highlight the rarity of this phenomenon as well as the unique questions regarding initiation, length, and choice of therapeutic anticoagulation in the absence of atrial fibrillation in these patients. Consideration of this diagnosis should be made in the absence of other cardioembolic etiologies with prompt management based on available guidelines.

• Aged
• Anticoagulants
• Humans
• Mitral Valve/surgery
• Prevalence
• Stroke Volume
• Thrombosis/epidemiology
• Thrombosis/etiology

• alpha-galactosidase
• cardiac resynchronization therapy with an implanted defibrillator
• fabry disease
• x chromosome

• Aged
• Aminobutyrates
• Arrhythmias, Cardiac/complications
• Biphenyl Compounds
• Cardiomegaly/complications
• Fabry Disease/complications
• Fabry Disease/diagnosis
• Humans
• Male
• Myocardial Infarction/complications
• Myocardial Infarction/etiology
• Pericardial Effusion
• Thrombosis/complications

• COVID-19
• Case report
• Embolization
• Heart failure
• Hypercoagulability
• Left ventricular thrombus

• Administration, Oral
• Anticoagulants/adverse effects
• Atrial Fibrillation/drug therapy
• Hemorrhage/chemically induced
• Hemorrhage/drug therapy
• Humans
• Ischemic Stroke
• Retrospective Studies
• Stroke/chemically induced
• Thrombosis/drug therapy
• United States
• Warfarin/adverse effects

• acute myocardial infarction
• anticoagulation
• left ventricular thrombus

• Administration, Oral
• Anticoagulants/adverse effects
• Atrial Fibrillation/drug therapy
• Female
• Fibrinolytic Agents/therapeutic use
• Humans
• Male
• Risk Factors
• Thrombosis/drug therapy
• Vitamin K

The management of patients with stroke is often multidisciplinary, involving various specialties and healthcare professionals. Given the common shared risk factors for stroke and cardiovascular disease, input may also be required from the cardiovascular teams, as well as patient caregivers and next-of-kin. Ultimately, the patient is central to all this, requiring a coordinated and uniform approach to the priorities of post-stroke management, which can be consistently implemented by different multidisciplinary healthcare professionals, as part of the patient ‘journey’ or ‘patient pathway,’ supported by appropriate education and tele-medicine approaches. All these aspects would ultimately aid delivery of care and improve patient (and caregiver) engagement and empowerment. Given the need to address the multidisciplinary approach to holistic or integrated care of patients with heart disease and stroke, the European Society of Cardiology Council on Stroke convened a Task Force, with the remit to propose a consensus on Integrated care management for optimizing the management of stroke and associated heart disease. The present position paper summarizes the available evidence and proposes consensus statements that may help to define evidence gaps and simple practical approaches to assist in everyday clinical practice. A post-stroke ABC pathway is proposed, as a more holistic approach to integrated stroke care, would include three pillars of management:

A: Appropriate Antithrombotic therapy.

• Atrial Fibrillation/drug therapy
• Cardiology
• Delivery of Health Care, Integrated
• Heart Diseases
• Humans
• Stroke/therapy

• DOAC
• LV thrombus
• Left ventricular thrombus
• NOAC

Noncompaction cardiomyopathy (NCCM) is a rare condition characterized by prominent trabeculae, deep intertrabecular recesses, and a left ventricular myocardium with a two‐layered structure, characterized by a spongy endocardial layer and a thinner and compacted epicardial one. NCCM can be isolated or associated with other congenital heart diseases and complex syndromes involving neuromuscular disorders and facial dysmorphisms. To date, more than 40 genes coding for sarcomeric, cytoskeletal, ion channels, and desmosomal proteins have been identified. Clinical presentation is also highly variable, ranging from no symptoms to end‐stage heart failure (HF), lethal arrhythmias, sudden cardiac death, or thromboembolic events. In particular, the prevalence of thromboembolism in NCCM patients appears to be higher than that of a similar, age‐matched population without NCCM. Thromboembolism has a multifactorial aetiology, which is linked to genetic, as well as traditional cardiovascular risk factors. In previous studies, atrial fibrillation (AF) was observed in approximately 25–30% of adult NCCM patients and embolism had a cardiac source in ~63–69% of cases; therefore, AF represents a strong predictor of adverse events, especially if associated to HF and neuromuscular disorders. Left ventricular dysfunction is another risk factor for thromboembolism, as a result of blood stagnation and local myocardial injury. Moreover, it is not completely clarified if the presence of deep intertrabecular recesses causing stagnant blood flow can constitute per se a thrombogenic substrate even in absence of ventricular dysfunction. For the clinical management of NCCM patients, an appropriate stratification of the thromboembolic risk is of utmost importance for a timely initiation of anticoagulant therapy. The aim of the present study is to review the available literature on NCCM with particular attention on thromboembolic risk stratification and prevention and the current evidence for oral anticoagulation therapy. The use of direct oral anticoagulants vs. vitamin K antagonists is also discussed with important implications for patient treatment and prognosis.

• Anticoagulant therapy
• Atrial fibrillation
• Left ventricular dysfunction
• Noncompaction cardiomyopathy
• Stroke
• Thrombosis

In clinical practice, edoxaban is sometimes prescribed for off-label use based on the hypothesis that it is as safe and effective as warfarin. However, there is limited safety information on off-label use due to lack of clinical trial. We aimed to analyze the tolerability of off-label use of edoxaban and to identify patient characteristics associated with major bleeding as adverse effects. Patients under edoxaban treatment between January 2017 and December 2017 were enrolled in this retrospective cohort study. The incidence of major bleeding with off-label use compared with on-label use was analyzed using by log-rank test. Univariate and multivariate regression analysis were undertaken to detect independent variables with significant odds ratio that associated with major bleeding. After the exclusion criteria were applied, the patients were divided into two groups: off-label group (n = 30) and on-label group (n = 161). Incidence of major bleeding was found to be higher in the off-label group (13.3%) than in the on-label group (3.7%) (p<0.05). Multivariate adjustment showed that the off-label use or portal vein thrombosis and patients with history of major bleeding has significantly higher incidence of major bleeding. We demonstrated that off-label use of edoxaban may be a significant risk factor for major bleeding.

• anticoagulants
• bleeding
• direct oral anticoagulants
• edoxaban
• off-label

• Direct oral anticoagulant
• Left ventricular thrombus
• ST elevation myocardial infarction
• Vitamin K antagonist
• Warfarin

• Aged
• Aged, 80 and over
• Anticoagulants/administration & dosage
• Anticoagulants/pharmacology
• Anticoagulants/standards
• Cohort Studies
• Factor Xa Inhibitors/administration & dosage
• Factor Xa Inhibitors/pharmacology
• Factor Xa Inhibitors/standards
• Female
• Heart Ventricles/drug effects
• Heart Ventricles/physiopathology
• Humans
• Male
• Middle Aged
• Retrospective Studies
• Thrombosis/drug therapy
• Thrombosis/physiopathology
• Treatment Outcome
• Warfarin/administration & dosage
• Warfarin/pharmacology
• Warfarin/standards

Hypertrophic cardiomyopathy is estimated to affect 1 out of every 500 adults in the USA. One of its main complications is left ventricular outflow obstruction, which may require surgical septal myectomy in severe cases. We report a rare complication of postoperative septal akinesis leading to thrombus formation presenting as an acute ischaemic stroke.

A 48-year-old woman presented with acute stroke 2 years after surgical septal myectomy for hypertrophic obstructive cardiomyopathy. Diagnostic workup identified an intraventricular thrombus arising in the left ventricular outflow tract (LVOT). After comprehensive evaluation, it was determined that the thrombus development was a complication of the prior septal myectomy causing focal septal akinesis. Treatment with anticoagulation resulted in improvement of neurological symptoms and resolution of the intraventricular thrombus.

This case illustrates the rarity and unusual presentation of an intracardiac thrombus that arises from septal myectomy site. A thrombus arising in the LVOT, which is characterized by high gradient laminar flow, is highly unusual. This suggests microscopic and macroscopic alteration in the ventricular septal wall structure, as evident by the septal wall akinesis seen on echocardiography. Recognition of this complication is critical to the selection of appropriate anticoagulation as secondary stroke prevention in these patients.

• Anticoagulation
• Case report
• Embolic stroke
• Hypertrophic cardiomyopathy
• Intraventricular thrombus

• anticoagulants
• diagnostic imaging
• embolism
• Echocardiography
• heart failure
• stroke
• venous thromboembolism

• Anticoagulants/adverse effects
• Anticoagulants/therapeutic use
• Fibrinolytic Agents/adverse effects
• Fibrinolytic Agents/therapeutic use
• Heart Diseases/diagnostic imaging
• Heart Diseases/drug therapy
• Heart Diseases/epidemiology
• Hemorrhage/chemically induced
• Humans
• Predictive Value of Tests
• Prevalence
• Risk Factors
• Thrombosis/diagnostic imaging
• Thrombosis/drug therapy
• Thrombosis/epidemiology
• Treatment Outcome

• Administration, Oral
• Anticoagulants/adverse effects
• Anticoagulants/therapeutic use
• Heart Ventricles/pathology
• Hemorrhage/etiology
• Humans
• International Normalized Ratio
• Stroke/drug therapy
• Thromboembolism/drug therapy
• Thromboembolism/pathology
• Thrombosis/drug therapy
• Thrombosis/mortality
• Thrombosis/pathology
• Vitamin K/antagonists & inhibitors

• anticoagulants
• anticoagulation
• cardiology
• stroke
• warfarin

• Administration, Oral
• Anticoagulants/adverse effects
• Atrial Fibrillation/drug therapy
• Hemorrhage/drug therapy
• Humans
• Retrospective Studies
• Stroke/drug therapy
• Thrombosis/drug therapy
• Treatment Outcome
• Warfarin/adverse effects

• UL1 TR001442 NCATS NIH HHS

• AHA Scientific Statements
• ischemic attack, transient
• secondary prevention
• stroke

• American Heart Association
• Clinical Decision-Making/methods
• Humans
• Ischemic Attack, Transient/epidemiology
• Ischemic Attack, Transient/prevention & control
• Practice Guidelines as Topic/standards
• Risk Reduction Behavior
• Stroke/epidemiology
• Stroke/prevention & control
• United States/epidemiology

• Fibrinolysis
• Late presentation
• Mechanical complications
• Myocardial infarction complications
• Percutaneous coronary interventions
• STEMI
• Thrombolysis

Patient: Male, 43-year-old

Final Diagnosis: Heart failure • HIV infection • thrombosis

Symptoms: Heart failure

Medication: —

Clinical Procedure: Echocardiography

Specialty: General and Internal Medicine

• cardiac magnetic resonance
• echocardiography
• endomyocardial fibrosis
• multimodality imaging
• pulmonary hypertension

• Adult
• Endomyocardial Fibrosis/complications
• Heart Ventricles/pathology
• Humans
• Hypertension, Pulmonary/complications
• Hypertension, Pulmonary/diagnostic imaging
• Hypertension, Pulmonary/pathology
• Hypertension, Pulmonary/physiopathology
• Magnetic Resonance Imaging
• Middle Aged
• Multimodal Imaging

• anticoagulants
• effectiveness
• safety
• ventricular thrombus
• warfarin

• Administration, Oral
• Anticoagulants/adverse effects
• Atrial Fibrillation/drug therapy
• Humans
• Prospective Studies
• Retrospective Studies
• Stroke
• Thrombosis/drug therapy
• Vitamin K

• cardiovascular medicine
• radiology
• venous thromboembolism

Rivaroxaban has been recently introduced for the management of non-valvular intra-cardiac thrombosis with variable results. We aimed to compare the results of the off-label use of rivaroxaban versus warfarin in the management of patients with left ventricle (LV) thrombus. This research is a retrospective study conducted on 63 patients who had LV thrombus from January to December 2016. We compared patients treated with warfarin (n=35) to patients who had rivaroxaban (n=28), and study outcomes were time to thrombus resolution, bleeding, stroke, and mortality.

The median duration of treatment was 9.5 (25th-75th percentiles: 6-32.5) months for rivaroxaban and 14 (3-41) months for warfarin. Thrombus resolution occurred in 24 patients in the warfarin group (68.6%) and 20 patients in the rivaroxaban group (71.4%). The median time to resolution in the warfarin group was 9 (4-20) months and 3 (2-11.5) months in the rivaroxaban group. Thrombus resolution was significantly faster in patients on rivaroxaban (p= 0.019). Predictors of thrombus resolution were thrombus surface area (HR: 1.21; CI 95% (1.0-1.46); p= .048) and the use of rivaroxaban (HR: 1.92; CI 95% (1.01-3.65); p= 0.048). There was no difference in stroke, bleeding, and mortality between both groups.

Rivaroxaban was as effective and safe as warfarin in managing patients with left ventricle thrombus. Larger randomized clinical trials are recommended to confirm our findings.

• Left ventricle thrombus
• Non-vitamin K dependent oral anticoagulant rivaroxaban
• Warfarin

• direct oral anticoagulants
• left ventricular thrombus
• vitamin K antagonists
• warfarin

• Direct oral anticoagulants
• Left ventricle thrombus
• Outcome
• Vitamin K antagonists
• Warfarin

Left ventricular thrombus (LVT) is a serious complication of acute myocardial infarction (MI) and also non-ischemic cardiomyopathies. We performed a narrative literature review, manual-search of reference lists of included articles and relevant reviews. Our literature review indicates that the incidence of LVT following acute MI has decreased, probably due to improvement in patient care as a result of better and earlier reperfusion techniques. Predictors of LVT include anterior MI, involvement of left ventricular (LV) apex (regardless of the coronary territory affected), LV akinesis or dyskinesis, reduced LV ejection fraction (LVEF), severe diastolic dysfunction and large infarct size. LVT is associated with increased risk of systemic embolism, stroke, cardiovascular events and death, and there is evidence that anticoagulant therapy for at least 3 months can reduce the risk of these events. Cardiac magnetic resonance (CMR) has the highest diagnostic accuracy for LVT, followed by echocardiography with the use of echocardiographic contrast agents (ECAs). Although current guidelines suggest use of vitamin K antagonist (VKA) for a minimum of 3 to 6 months, there is growing evidence of the benefits of direct acting oral anticoagulants in treatment of LVT. Embolic events appear to occur even after resolution of LVT suggesting that anticoagulant therapy needs to be considered for a longer period in some cases. Recommendations for the use of triple therapy in the presence of the LVT are mostly based on extrapolation from outcome data in patients with atrial fibrillation (AF) and MI. We conclude that the presence of LVT is more likely in patients with anterior ST-segment elevation MI (STEMI) (involving the apex) and reduced ejection fraction (EF). LVT should be considered a marker of increased long-term thrombotic risk that may persist even after thrombus resolution. Ongoing clinical trials are expected to elucidate the best management strategies for patients with LVT.

• Left ventricular thrombus (LVT)
• apical thrombus
• apixaban
• dabigatran
• rivaroxaban
• thrombosis
• warfarin

• Anticoagulants/therapeutic use
• Antithrombins/therapeutic use
• Dabigatran/therapeutic use
• Embolism/etiology
• Embolism/prevention & control
• Factor Xa Inhibitors/therapeutic use
• Heart Diseases/complications
• Heart Diseases/drug therapy
• Heart Ventricles
• Hemorrhage/chemically induced
• Hemorrhage/epidemiology
• Humans
• Odds Ratio
• Pyrazoles/therapeutic use
• Pyridines/therapeutic use
• Pyridones/therapeutic use
• Rivaroxaban/therapeutic use
• Thiazoles/therapeutic use
• Thrombosis/complications
• Thrombosis/drug therapy
• Warfarin/therapeutic use