Cor Vasa 2025, 67(3):408-411 | DOI: 10.33678/cor.2024.044

A Rare Case of Acute Limb Ischemia due to Left Ventricular Thrombus in Ischemic Heart Disease: Different Approaches to Long-Term Anticoagulant and Antiplatelet Therapy

Meity Ardiana^a, Ovin Nada Saputri^b, Muhammad Surya Tiyantara^a, Michael Jonatan^a, Andrianto^a, Anudya Kartika Ratri^a

^a Department of Cardiology and Vascular Medicine, Faculty of Medicine, Airlangga University - Dr. Soetomo Academic General Hospital, Surabaya, Indonesia

^b Faculty of Medicine, Airlangga University, Surabaya, Indonesia

Left ventricular thrombus (LVT) may develop from the progression of coronary artery disease (CAD), which can rarely embolise and migrate to the peripheral artery. Here, we report the case of a 58-year-old man admitted to our hospital with a sudden onset of pain and numbness in his right lower limb, diagnosed as ALI. Unexpectedly, he also had silent and extensive CAD leading to heart failure with reduced ejection fraction (HFrEF) and LVT formation. LVT embolization in the peripheral artery was identified as the cause of ALI in this patient. Effective long-term antithrombotic therapy was necessary to reduce cardiovascular adverse events and disease progression. Patients with ALI coexisting with complex CAD and LVT may require a combination of anticoagulant and antiplatelet therapy. Therefore, an individualised approach is warranted. This approach is based on the evaluation of the ischemic and bleeding risks of the patient to achieve a greater reduction in ischemic events while avoiding significant bleeding events.

Keywords: Acute limb ischemia, Anticoagulant, Antiplatelet, Ischemic cardiomyopathy, Left ventricular thrombus

Received: March 28, 2024; Revised: May 8, 2024; Accepted: May 24, 2024; Prepublished online: June 2, 2012; Published: June 20, 2025  Show citation