Title

Etiology, Treatment and Outcomes in Patients With Left Ventricular Thrombus - Experiences From an African Center

Document Type

Article

Department

Internal Medicine (East Africa); Brain and Mind Institute

Abstract

Introduction: Left ventricular thrombus (LVT) may lead to thromboembolism and has been associated with increased morbidity and mortality. Little is known about the incidence, etiology and outcomes in patients with LVT in Africa.

Objectives: To determine the etiology, treatment practices, rate of resolution and outcomes in patients with LVT in the region.

Methods: A review of all echocardiograms performed in 2017 and 2018 at the Aga Khan University Hospital, Nairobi was carried out and patients with LVT identified. Physician review of charts was performed to document clinical characteristics and outcomes.

Results: During the study period 100 patients with LVT were identified (1.3% of adult echoes). The mean LVEF was 28.5% (±11.0%) and 88% of the patients had an LVEF of less than 40%. Underlying etiology of LV dysfunction was post MI in 28%, chronic ischemic cardiomyopathy in 42% and non ischemic cardiomyopathy in 30%. In 15% of the patients a stroke or TIA predated the diagnosis of LVT. Long term anticoagulation was given to 92 patients. Among these, 37% received warfarin while 63% were treated with a DOAC (rivaroxaban (50%), dabigatran(7.6%) and apixaban(5.4%)). In 60% of the patients, anticoagulation was continued beyond a year. In patients with reassessment imaging (64%, median time 177 days), complete thrombus resolution was noted in 59.4%. One year follow-up data was available for 85 patients: 13 (15.3%) patients had died, 4 (4.7%) had suffered a stroke, and 8(9.4%) had a bleeding episode. Rates of thrombus resolution, stroke and bleeding were not significantly different among patients treated with warfarin and DOAC (Figure 1).

Conclusions: We noted a high incidence of LVT compared to contemporary Western series. The majority of our patients were treated with DOACs. There were no significant differences in outcomes between patients treated with a DOAC and those receiving warfarin. Prospective evaluation on the efficacy and safety of DOACs for this indication is needed.

Publication

American Heart Association Journal

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