Valeriani Emanuele, Astorri Giulia, Pannunzio Arianna, Pastori Daniele, Palumbo Ilaria Maria, Menichelli Danilo, Donadini Marco Paolo, Santagata Davide, Satula Katarzyna, De Candia Erica, D'Innocenzo Luca, Tufano Antonella, Marcucci Rossella, Berteotti Martina, Chistolini Antonio, Dragoni Francesco, Bucci Tommaso, Ageno Walter, Becattini Cecilia, Pignatelli Pasquale
Department of General Surgery and Surgical Specialty Paride Stefanini, Sapienza University of Rome, Rome, Italy.
Department of Infectious Disease, Azienda Ospedaliero-Universitaria Policlinico Umberto I, Viale del Policlinico, 155, Rome, Italy.
Intern Emerg Med. 2025 Apr 3. doi: 10.1007/s11739-025-03922-6.
Optimal duration of anticoagulant therapy for left ventricular thrombous (LVT) is unclear. The aim of this study is to evaluate effectiveness and safety of vitamin K antagonists (VKAs) up to 12 months in patients with LVT. Patients diagnosed with LVT between 2011 and 2023 and treated with VKAs until LVT resolution or up to 12 months were enrolled in a retrospective cohort study. Primary outcome included on-treatment LVT resolution, secondary outcomes acute ischemic stroke, myocardial infarction, peripheral embolism, and major and clinically relevant non-major bleedings during the 12-month follow-up. Ninety patients were included. Median age was 66 years and 78.9% were male. Mean time in therapeutic range was 61% and 32.9% of patients received VKA monotherapy, with the remaining concomitant antiplatelet treatment. The 3, 6, 12 months cumulative incidences of LVT resolution were 27% (95% confidence intervals -95%CI-, 18%-36%), 47% (95%CI 36%-57%), and 70% (95% CI 60%-79%), respectively. At Cox regression model, reduced left ventricular ejection fraction (Hazard Ratio 0.48; 95%CI 0.24-0.95) and left-ventricular aneurysms (Hazard Ratio 0.44; 95%CI 0.22-0.88) were associated with reduced LVT resolution. One patient developed an acute ischemic stroke and one an acute myocardial infarction. Two patients developed a major and four a clinically relevant non-major bleeding. Incidence of LVT resolution appeared to be higher at 12 than at 3 and 6 months of follow-up, and the rates of on-treatment acute arterial and bleeding events were low. Reduced left ventricular ejection fraction and left-ventricular aneurysm appeared to be associated with a lower rates of LVT resolution.
左心室血栓（LVT）抗凝治疗的最佳持续时间尚不清楚。本研究的目的是评估维生素K拮抗剂（VKA）治疗长达12个月对LVT患者的有效性和安全性。2011年至2023年间诊断为LVT并接受VKA治疗直至LVT消退或长达12个月的患者被纳入一项回顾性队列研究。主要结局包括治疗期间LVT消退，次要结局为12个月随访期间的急性缺血性卒中、心肌梗死、外周栓塞以及严重和临床相关的非严重出血。纳入了90例患者。中位年龄为66岁，78.9%为男性。治疗范围内的平均时间为61%，32.9%的患者接受VKA单药治疗，其余患者接受联合抗血小板治疗。LVT消退的3个月、6个月、12个月累积发生率分别为27%（95%置信区间-95%CI-，18%-36%）、47%（95%CI 36%-57%）和70%（95%CI 60%-79%）。在Cox回归模型中，左心室射血分数降低（风险比0.48；95%CI 0.24-0.95）和左心室动脉瘤（风险比0.44；95%CI 0.22-0.88）与LVT消退减少相关。1例患者发生急性缺血性卒中，1例发生急性心肌梗死。2例患者发生严重出血，4例发生临床相关的非严重出血。LVT消退的发生率在随访12个月时似乎高于3个月和6个月时，且治疗期间急性动脉事件和出血事件的发生率较低。左心室射血分数降低和左心室动脉瘤似乎与LVT消退率较低相关。
