In patients with resolved LV thrombus post-MI after 3-6 months of anticoagulation, would you consider surveillance imaging for thrombus recurrence if there is persistent apical akinesis?

A common and sometimes challenging scenario. If there is persistent LV dysfunction (EF <40%) with apical akinesis /aneurysm, I maintain anticoagulation regardless of thrombus resolution. Recurrence of thrombus, even after echo imaging evidence of resolution in this state has been observed. There is ...

There is no good data to guide surveillance in this cases. If the patient remains with low EF and an akinetic apex, I usually don't stop anticoagulation at all as long as they are tolerating. This is simply because being wrong on this would be an intolerable outcome.

If the LV function improves wit...