A 68-year-old woman post anterior MI 6 weeks ago has a repeat echo showing EF of 30% and a large apical thrombus on imaging. She has no contraindications to anticoagulation. The preferred anticoagulation strategy for the left ventricular thrombus is:

• A Dabigatran 150 mg twice daily for 3 months
• B Aspirin 300 mg plus clopidogrel for 3 months
• C No anticoagulation; antiplatelet therapy suffices
• D Warfarin (INR target 2.0–3.0) for at least 3 months ✓

Explanation

Left ventricular thrombus after MI is a class IIa indication for anticoagulation with vitamin K antagonists (warfarin, INR 2–3) for at least 3 months, based on older studies and current ACC/AHA 2023 guidance; DOACs (dabigatran, rivaroxaban) lack robust randomised data specifically for LV thrombus, though emerging trials (ADONIS) suggest potential efficacy. Antiplatelet therapy alone is insufficient for thrombus dissolution. The thrombus should be reassessed by imaging at 3 months to guide duration of treatment.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

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Written and medically reviewed by the StethoPrep medical team.