medjournalМедицинский журналMedical Journal1818-426XБелорусский государственный медицинский университет10.51922/1818-426X.2023.3.4medjournal-122Research ArticleОБЗОРЫ И ЛЕКЦИИREVIEWS AND LECTURESТромбоз левого желудочка клинической практикеLeft ventricular thrombosis in clinical practiceБорисА. М.BorysA. M.СавченкоМ. А.SavchenkoM. A.УО «Белорусский государственный медицинский университет»Belarus20231806202503411Copyright © Борис А.М., Савченко М.А., 20252025Борис А.М., Савченко М.А.Borys A.M., Savchenko M.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://medjournal.ejournal.by/jour/article/view/122

Тромбоз левого желудочка является потенциально опасным для жизни состоянием из-за высокого риска инсульта и других системных тромбоэмболий. Несмотря на широкое применение чрескожных коронарных вмешательств и двойной антитромбоцитарной терапии, в клинической практике чаще всего он является осложнением острого инфаркта миокарда, реже встречается при ишемической и неишемических кардиомиопатиях. Статья посвящена тромбозу левого желудочка при различных заболеваниях. Указаны факторы риска и патофизиологические механизмы тромбообразования, предикторы эмболических осложнений. Описаны современные визуализационные методы исследования, позволяющие значительно улучшить диагностику тромбоза левого желудочка. Отмечено, что магнитно-резонансная томография сердца с отсроченным контрастированием гадолинием является наиболее информативным методом визуализации при тромбозе левого желудочка, далее по точности диагностики следует эхокардиография с контрастным усилением. Особое внимание уделено применению в лечении антагонистов витамина К и прямых оральных антикоагулянтов. Показано, что появляется все больше доказательств преимуществ оральных антикоагулянтов прямого действия при лечении пациентов с тромбозом левого желудочка. Отмечено, что проводимые в настоящее время клинические исследования помогут определить наиболее эффективные схемы лечения таких пациентов.

Left ventricular thrombosis is a potentially life-threatening condition due to a significant risk of stroke and systemic thromboembolism. Despite the more frequent use of primary percutaneous coronary interventions and dual antiplatelet therapy in clinical practice the majority of left ventricular thrombus are diagnosed after myocardial infarction, although such a complication can occur both in ischaemic and non-ischaemic cardiomyopathies. The article provides information on left ventricular thrombosis in internal diseases according to current concepts. The authors characterize risk factors and pathophysiological mechanisms in thrombosis, the predictors of embolic events. Modern imaging methods for diagnosis of left ventricular thrombosis are described. The article outlines that cardiac magnetic resonance has the highest diagnostic accuracy, followed by echocardiography with the use of echocardiographic contrast agents. Particular attention is paid to the treatment with vitamin K antagonists and direct oral anticoagulants. There is growing evidence of the benefits of direct acting oral anticoagulants in treatment of left ventricular thrombosis. It is expected that ongoing clinical trials will help elucidate the best management strategies for these patients.

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The authors declare that there are no conflicts of interest present.