Anticoagulation for Left Ventricular Thrombi Secondary to COVID -- Is Three Months Too Long? (preprint)

Length of anticoagulation for thrombotic events related to COVID-19 is unknown. We present a patient with COVID-19 complicated by a thrombotic anterior STEMI and multiple left ventricular (LV) thrombi that resolved after 8 weeks of anticoagulation. We suggest a shorter length of anticoagulation with COVID-19 related LV thrombus.

Anticoagulation for Left Ventricular Thrombi Secondary to COVID – Is Three Months Too Long?: A Case Report (preprint)

Background: Venous and arterial thromboembolic events are common sequelae of COVID-19 infection. However, there are no set guidelines as to the appropriate duration of anticoagulation for such thrombotic events. Case Presentation: A 62-year-old woman presented with chest pain 2 weeks after she was diagnosed with COVID-19. She was found to have an anterior STEMI with a thrombotic occlusion of the left anterior descending artery as well as multiple left ventricular (LV) thrombi. The patient was treated with guideline directed medical therapy for acute coronary syndrome. As for the LV thrombi, she was bridged from heparin to warfarin with plan to continue anticoagulation for a minimum of 3 months; however, she was noted to have resolution of the thrombi in 2 months with no subsequent recurrence. Conclusion: In the setting of an acute myocardial infarction with apical akinesis, an LV thrombus is not uncommon. In such cases, ACC/AHA recommends oral anticoagulation (OAC) for 3 months while ESC recommends OAC for up to 6 months. There have been no large studies looking at the optimal duration for OAC for LV thrombi due to COVID-19. Given resolution of the thrombi in our patient within 2 months, we suggest a shorter length of anticoagulation for such cases guided by echocardiographic imaging. However, prospective data regarding this matter is first needed.