Systematic Review of Antiphospholipid Syndrome and Left Ventricular Thrombus

Left ventricular thrombus is a potentially devastating complication of anti-phospholipid syndrome (APLS). To date there have been no systematic reviews of this topic.

We systematically searched MEDLINE, EMBASE, Cochrane, ISI, and CINAHL for cases of left ventricular thrombi in APLS. We also included a case seen at our institution. Both English and non-English language citations were included. Keywords included “intracardiac” AND “antiphospholipid”, or “antiphospholipid syndrome” AND “cardiac thrombus”, or in MEDLINE with MeSH operator “antiphospholipid syndrome” AND “thrombus.” A total of 669 citations were found. Twenty-six met our criteria.

There are a total of 28 cases of left ventricular thrombus in APLS (Table 1). The median age was 38 (±15.1 yrs). Fifteen (54%) were women, 12 (43%) were men and 1 was of unknown sex. Five (18%) died, 21 (75%) survived to discharge and 2 (7.1%) had unknown vital status. Nineteen (68%) had a positive cardiolipin antibody, 7 were unknown (25%) and 2 were negative (7.1%). Fourteen (50%) had a positive lupus anticoagulant, and 14 (50%) were unknown. Eight were treated with anticoagulation alone (29%). Of those, 7 recovered (25%) and one was unknown (3.6%). Three (10.7%) were treated with anticoagulation and corticosteroids, and all 3 recovered. In eight (29%), surgical thrombectomy and anticoagulation were utilized. Of the 8 who had surgery, 6 recovered (21%) and 2 died (7.1%).

In this systematic review we have shown that death may be less common than previously reported (33% [Lim, et. al, Intern Med J. 2004 Mar;34(3):135-7] vs. 18% in our study). A high index of suspicion is warranted.

No relevant conflicts of interest to declare.