Direct oral anticoagulants were associated with a similar incidence of stroke or systemic embolism compared to vitamin K antagonists (4.0% vs. 6.5%; P=0.657).
Cohort (n=87)
No
Do direct oral anticoagulants (DOACs) improve efficacy and safety outcomes compared to vitamin K antagonists in patients with left ventricular thrombus?
In a retrospective cohort, DOACs demonstrated similar efficacy and safety to VKAs for the treatment of left ventricular thrombus, supporting their potential use pending randomized trial confirmation.
Absolute Event Rate: 4% vs 6.5%
p-value: p=0.657
BACKGROUND: A retrospective cohort study was conducted to compare the efficacy and safety of direct oral anticoagulants (DOACs) and vitamin K antagonists (VKAs) in the treatment of patients with left ventricular thrombus (LVT). METHODS: Consecutive patients admitted to our institution with LVT between February 2009 and December 2020 and treated with either DOACs or VKAs were considered for inclusion in this study. The outcomes included stroke or systemic embolism (SSE), thrombus resolution, and bleeding events. RESULTS: Eighty-seven patients with LVT were identified. Of these, 25 patients were treated with DOACs and 62 patients were treated with VKA. The average follow-up period was 2.37±2.1 years. DOACs were associated with similar incidences of stroke (4.0% vs. 4.8%; P=0.158), systemic embolism (0% vs. 1.6%; P=0.906), SSE (4.0% vs. 6.5%; P=0.657), thrombus resolution (76.0% vs. 74.2%; P=0.057), and blooding events (4.0% vs. 3.2%; P=0.858) as compared to VKAs. In the univariate logistic regression analysis, there was a significant difference between the DOAC and VKA groups in the incidence of SSE when antiplatelets were controlled odds ratio (OR) =0.34, 95% confidence interval (CI): 0.21, 0.98; P=0.027. However, in the multivariate analysis, antiplatelets had no significant effect on the outcome (OR =0.41, 95% CI: 0.36, 1.54; P=0.366). CONCLUSIONS: DOACs had similar efficacy and safety to VKAs in the treatment of patients with LVT. Randomized controlled trials should be conducted to verify our findings.
Xu et al. (Thu,) conducted a cohort in left ventricular thrombus (n=87). Direct oral anticoagulants (DOACs) vs. Vitamin K antagonists (VKAs) was evaluated on stroke or systemic embolism (SSE) (p=0.657). Direct oral anticoagulants were associated with a similar incidence of stroke or systemic embolism compared to vitamin K antagonists (4.0% vs. 6.5%; P=0.657).