DOAC therapy was non-inferior to Warfarin for LV thrombus, with 1-year composite mortality and stroke rates of 23.8% vs 26.7% (OR 0.855, P=0.138).
Does DOAC therapy reduce the composite of all-cause mortality and stroke compared to warfarin in adult patients with left ventricular thrombus?
In a large propensity-matched cohort, DOACs were associated with similar rates of mortality, stroke, and bleeding compared to warfarin for the treatment of left ventricular thrombus.
Absolute Event Rate: 0% vs 0%
Abstract Background and Purpose Left ventricular (LV) thrombus can develop in patients with both ischemic and nonischemic cardiomyopathies. Anticoagulation is recommended to reduce the risk of stroke or systemic embolism. However, existing studies on the effectiveness of direct oral anticoagulants (DOACs) for this indication are often contradictory, have small sample sizes, and include limited follow-up periods. Therefore, we aimed to compare the outcomes associated with DOAC use versus Warfarin use for the treatment of LV thrombus in a large patient cohort. Methods We conducted a retrospective cohort analysis of deidentified, aggregate patient data from the TriNetX research network. Adult patients with with echocardiographically diagnosed LV thrombus between 1/2012 and 1/2022 were identified. Patients were divided into two groups based on DOAC or Warfarin use for management of LV thrombus. Following a tight 1:1 propensity score matching for baseline demographics, prescribed medications, comorbidities and baseline hemoglobin, we calculated odds ratios and Cox proportional hazards ratios to compare 30-day and 1-year outcomes. Primary outcome included the composite of all-cause mortality and stroke. Secondary outcomes included stroke, all-cause mortality and significant bleeding (with or without needing transfusion). Results The matched cohort included 1,890 patients with LV thrombus who were started on DOACs or Warfarin (n=945 per group; mean age: 61.9 years; 28% female; 62% White). The composite outcome of all-cause mortality and stroke did not differ significantly between the two groups at 30-days (DOAC: 13.3% vs. Warfarin: 15%; OR: 0.87 95% CI: 0.67–1.13; P=0.291) and 1-year (DOAC: 23.8% vs. Warfarin: 26.7%; OR: 0.855 95% CI: 0.69–1.05; P=0.138). The 1-year independent risk of stroke also did not differ significantly (DOAC: 13.9% vs. Warfarin: 15.1%; OR: 0.903 95% CI: 0.70–1.17; P=0.43) between the two groups as well as the 1-year independent risk of death (DOAC: 11.9% vs. Warfarin: 14.2%; OR: 0.814 95% CI: 0.62–1.06; P=0.13). Bleeding risk at 1-year was also comparable in the two groups (DOAC: 4.8% vs. Warfarin: 4.7%; OR: 1.049 95% CI: 0.68–1.61; P=0.83).Time-to-event analysis of primary outcomes are depicted in Figure 1. Conclusions In a large cohort of patients with LV thrombus, DOAC therapy was non-inferior to Warfarin therapy with respect to all-cause mortality and stroke, thereby supporting the use of DOACs in this clinical setting.Time to event analysis of outcomes
Kassab et al. (Sat,) reported a other. DOAC therapy was non-inferior to Warfarin for LV thrombus, with 1-year composite mortality and stroke rates of 23.8% vs 26.7% (OR 0.855, P=0.138).