L Ventricular Thrombus Despite Prescribed Direct Oral Anticoagulant Therapy in Chronic Heart Failure

Left ventricular thrombus keeps forming despite DOACs. The problem isn't always the drug. A 65-year-old with HFrEF, prior MI, and an LV apical aneurysm presented with a newly detected apical thrombus on transthoracic echocardiogram. He was already prescribed apixaban for stroke prevention. 🔸 The thrombus persisted on repeat imaging months later, despite anticoagulation. The patient remained asymptomatic throughout. 🔸 Poor medication adherence was documented as a contributing factor. But the case raises a harder question: is medication adherence the full story here? 🔸 Current LVT management relies on generalized duration guidelines that don't account for thrombus morphology, degree of ventricular remodeling, or individual thrombotic burden. 🔸 Risk stratification currently lacks integration of imaging phenotypes, AI-assisted morphology assessment, and emerging genomic markers that might predict which thrombi will persist or recur. 🔸 CMR and advanced imaging were planned for characterization, but the workflow gap between detection and personalized risk assessment remains wide in clinical practice. The authors make a strong case: one-size-fits-all anticoagulation duration is failing a subset of HFrEF patients. What we need is individualized, risk-adapted strategies that combine thrombus imaging features, ventricular function trajectories, and patient-level factors to decide when to escalate, switch, or extend therapy. Ayana G et al. https://pubmed.ncbi.nlm.nih.gov/42633... At Axonovyn, we're building the data backbone to harmonize fragmented echocardiogram reports, CMR interpretations, medication adherence records, and genomic data into clean, queryable datasets. That's how clinics move from reactive LVT management to prospective risk models. If you're seeing this pattern in your patient population or running a thrombosis research program, let's talk about how to structure your data for prediction. Email axonovyn@gmail.com to pilot a collaboration. #HeartFailure #Thromboembolism #CardiacImaging #ClinicalDecisionMaking #DataIntegration #PatientRiskStratification