CARDIOVASCULAR JOURNAL OF AFRICA • Volume 34, No 1, January–April 2023 AFRICA 53 AHA advocate administration of vitamin K antagonist therapy for a period of three months for treatment of LVT,12 whereas the ESC recommends the use of an OAC for a period of six months, complemented by repeat echocardiography, at which time consideration to stop anticoagulation should be made if the thrombus has completely dissolved.2 At Chris Hani Baragwanath Hospital the practice is to use a vitamin K antagonist for three months (more aligned with the ACCF/AHA guidelines), followed by repeat echocardiography, at which time OAC is stopped if the thrombus has completely dissolved. With this strategy of short-term OAC we have not observed adverse events in these patients. Although the mainstay of treatment for LVT is vitamin K antagonists, off-label use of non-vitamin K antagonists (NOACs) have demonstrated efficacy in thrombus resolution in several case reports.14-16 For this reason, the EARLY-MYO-LVT trial, a prospective, multicentre, randomised, controlled trial is currently in progress. The aim of the study is to determine the safety and efficacy of rivaroxaban compared to warfarin in the management of LVT subsequent to MI.17 Until the completion Fig. 4. 3D TOE 120° three-chamber view showing the LVT (white arrow) protruding into the LVOT. Fig. 5. 3D TOE short-axis view at the aortic valve level showing the opening of the aortic valve and the LVT (white arrow) protruding into the LVOT. Fig. 6. Diagnostic coronary angiogram showing the midlateral anterior descending artery total occlusion with Rentrop1 collaterals. Fig. 7. (A) Ciné CMR image showing thrombus (white arrow) and thinning of the anterior and anteroseptal wall. (B) Late gadolinium enhancement imaging showing transmural infarction of the anterior and anteroseptal wall with associated thrombus (white arrow). A B
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