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CC BY 4.0 · Thromb Haemost
DOI: 10.1055/a-2702-2298
Review Article

Management of Antithrombotic Therapy in Left Ventricular Thrombus: A Position Paper of the Italian Society of Hemostasis and Thrombosis (SISET)

Authors

  • Emanuele Valeriani 

    1   Department of General Surgery, Surgical Specialty and Anesthesiology, Sapienza University of Rome, Rome, Italy
    2   Department of Infectious Disease, Azienda Ospedaliero-Universitaria Policlinico Umberto I, Roma, Italy

  • Arianna Pannunzio

    1   Department of General Surgery, Surgical Specialty and Anesthesiology, Sapienza University of Rome, Rome, Italy

  • Danilo Menichelli

    1   Department of General Surgery, Surgical Specialty and Anesthesiology, Sapienza University of Rome, Rome, Italy

  • Domenico Prisco

    3   Dipartimento di Medicina Sperimentale e Clinica, Università di Firenze, Florence, Italy

  • Walter Ageno

    4   Department of Medicine and Surgery, University of Insubria, Varese, Italy

  • Daniele Pastori   ‡

    5   Department of Medical and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
    6   IRCCS Neuromed, Pozzilli, Italy

  • Pasquale Pignatelli   ‡

    5   Department of Medical and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
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Abstract

Left ventricular thrombus (LVT) represents a potential life-threatening condition burdened by a significant risk of systemic embolism. Despite the relevance of the disease, there are scanty data on antithrombotic management of LVT mostly deriving from small observational studies and few randomized controlled trials. It has been reported that anticoagulant therapy reduces the rate of thrombus formation, allows thrombus resolution in most cases, and limits the risk of embolic complications. Several issues, however, still remain unresolved and clinicians caring for these patients have to decide on the need and on the regimen of antithrombotic therapy based on their expertise and data from different clinical scenario. This position paper of the Italian Society of Hemostasis and Thrombosis (SISET) aims to provide practical advice and guidance in the form of text, tables, and figures for clinicians dealing with LVT. Relevant clinical questions related to LVT have been identified concerning the identification of patients at risk; the role of anticoagulant prophylaxis on LVT development; the type, dose, and duration of anticoagulant therapy; and the management of patients receiving concomitant antiplatelet therapy. A systematic search has been performed to identify available evidence on the topic that has been carefully and critically reviewed by the national expert authors to support the suggestions and recommendations.

Keywords

acenocoumarol - anticoagulants - heparin - venous thromboembolism - warfarin

‡ These authors share co-senior authorship.


Supplementary Material



Publikationsverlauf

Eingereicht: 25. November 2024

Angenommen: 11. August 2025

Accepted Manuscript online:
16. September 2025

Artikel online veröffentlicht:
25. September 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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