Treatment of left ventricular thrombi with a low molecular weight heparin

Background: Once a diagnosis of left ventricular thrombus has been established, the classical attitude consists in the administration of unfractionated heparin relayed by oral anticoagulation therapy. However, the use of unfractionated heparins in this indication was only assessed in an open, non-randomized study with no control group, including 23 patients. On the other hand, although low molecular weight heparins are routinely used in some departments, there are no studies available concerning these agents in this indication. The aim of this study was to evaluate the feasibility of low molecular weight heparin therapy in patients with left ventricular thrombi. Methods: The study was a prospective, non-randomized, open-label trial. All patients with a new left ventricular thrombus diagnosed between September 2000 and September 2003 received enoxaparine 100 IU/kg twice daily for a mean duration of 13 days. A relay treatment with fluindione was initiated on day 5. The left ventricular thrombus outcome was followed for 3 weeks by bi-weekly transthoracic echocardiography. Results: 26 left ventricular thrombi were diagnosed over the 3-year study period: 19 in post-infarct patients with a history of anterior myocardial infarction and 7 in patients with dilated cardiomyopathy. The mean thrombus area decreased from 2.30±0.32 to 0.36±0.11 cm2 (p<0.0001). Nineteen thrombi out of twenty-six (73%) disappeared during the treatment period. No thrombocytopenia or hemorrhagic events were observed. One transient ischemic attack was reported. Conclusion: This preliminary study suggests that low molecular weight heparins are well tolerated and efficient in terms of left ventricular thrombi disappearance or size reduction.