What is the clinical evidence from this study?

Study design: Observational. Population: Left ventricular thrombus (n=90). Intervention: Vitamin K antagonists (VKAs). Primary outcome: On-treatment left ventricular thrombus resolution at 12 months (95% CI 60%-79%).

What does this research mean for the field?

Vitamin K antagonist therapy in patients with left ventricular thrombus results in a 70% cumulative incidence of thrombus resolution at 12 months, with low rates of bleeding and arterial events. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

April 3, 2025Open Access

Long-term left ventricular thrombosis resolution in patients receiving vitamin k antagonists: a multicenter observational study

Key Result

Vitamin K antagonist therapy in patients with left ventricular thrombus resulted in a 70% cumulative incidence of thrombus resolution at 12 months.

Study Design

Type

Observational (n=90)

Multicenter

Yes

Structured PICO

Population

90 patients with left ventricular thrombosis (LVT), median age 66, 78.9% male, based in Italy. Excluded: DOAC treatment, treatment duration <3 months, other indications for VKAs.

Intervention

Vitamin K antagonists (warfarin, acenocoumarol) targeted to specific INR values, administered until LVT resolution or up to 12 months. 32.9% received VKA monotherapy, others received concomitant antiplatelet therapy.

Outcome

On-treatment LVT resolution during the 12-month follow-up, defined by LVT disappearance at imaging (transthoracic echocardiography, computed tomography, or magnetic resonance imaging)surrogate

In patients with left ventricular thrombosis, VKA therapy resulted in a 70% resolution rate at 12 months, with reduced LVEF and LV aneurysms identifying patients at higher risk of persistent thrombosis.

Limitations

Relatively low number of included patients
Selection bias due to exclusion of patients lacking relevant data or receiving non-VKA anticoagulants
Retrospective nature did not allow collection of additional patient characteristics
Diagnostic and treatment decisions were at the discretion of attending clinicians without standardized algorithms
Long study period introduces potential variability in clinical practices, treatments, and technologies over time
LVT resolution time was approximated using data from available radiological imaging performed during follow-up
Low number of events limited the evaluation of further potential confounders

Abstract

Optimal duration of anticoagulant therapy for left ventricular thrombous (LVT) is unclear. The aim of this study is to evaluate effectiveness and safety of vitamin K antagonists (VKAs) up to 12 months in patients with LVT. Patients diagnosed with LVT between 2011 and 2023 and treated with VKAs until LVT resolution or up to 12 months were enrolled in a retrospective cohort study. Primary outcome included on-treatment LVT resolution, secondary outcomes acute ischemic stroke, myocardial infarction, peripheral embolism, and major and clinically relevant non-major bleedings during the 12-month follow-up. Ninety patients were included. Median age was 66 years and 78.9% were male. Mean time in therapeutic range was 61% and 32.9% of patients received VKA monotherapy, with the remaining concomitant antiplatelet treatment. The 3, 6, 12 months cumulative incidences of LVT resolution were 27% (95% confidence intervals -95%CI-, 18%-36%), 47% (95%CI 36%-57%), and 70% (95% CI 60%-79%), respectively. At Cox regression model, reduced left ventricular ejection fraction (Hazard Ratio 0.48; 95%CI 0.24-0.95) and left-ventricular aneurysms (Hazard Ratio 0.44; 95%CI 0.22-0.88) were associated with reduced LVT resolution. One patient developed an acute ischemic stroke and one an acute myocardial infarction. Two patients developed a major and four a clinically relevant non-major bleeding. Incidence of LVT resolution appeared to be higher at 12 than at 3 and 6 months of follow-up, and the rates of on-treatment acute arterial and bleeding events were low. Reduced left ventricular ejection fraction and left-ventricular aneurysm appeared to be associated with a lower rates of LVT resolution.

اسأل الذكاء الاصطناعي

Bookmark

View Full Paper