The absence of LVT recurrence in a clearly defined low-risk subgroup raises important implications for discontinuing OAC after LVT resolution. A retrospective cohort study presented at the American Heart Association (AHA) 2025 Scientific Sessions evaluated which patients may safely stop anticoagulation once LVT resolves.

The study enrolled 116 patients with documented LVT resolution who completed their OAC course and excluded individuals with LV aneurysm. The mean age was 64.5 ± 15.0 years, and 50% were male. Ischemic cardiomyopathy was present in 64.6% of the cohort. LVT recurred in 19% (22/116) during follow-up.

Patients with recurrence were older (71.3 ± 11.9 vs. 63.4 ± 15.7 years; p = 0.03), had higher rates of prior ischemic stroke or arterial thromboembolism (18.2% vs. 4.3%; p = 0.02), and had significantly lower LVEF at the time of thrombus resolution (33.4 ± 13.6% vs. 42.5 ± 15.5%; p = 0.012). Stroke, systemic embolism, and mortality rates did not differ by recurrence status.

The most significant finding was the complete absence of recurrence in patients who had LVEF >50% and no prior stroke (0/32). This combination identified a subgroup with very low thrombotic risk after OAC discontinuation.

Patients without LV aneurysm who have preserved LVEF and no history of stroke show a very low risk of recurrence and may safely discontinue OAC after LVT resolution. This approach reduces exposure to long-term anticoagulation in individuals who meet these favorable clinical criteria.