Evaluation of Direct Oral Anticoagulants Versus Warfarin for Intracardiac Thromboses

ABSTRACT: Intracardiac thrombus (ICT) formation is a common complication of several cardiovascular diseases. Warfarin is recommended for treatment of ICT by guidelines based on observational studies occurring before the advent of nonvitamin K antagonist direct oral anticoagulants (DOACs). We aim to evaluate the current prescribing patterns at our institution and to compare the efficacy and safety profiles of warfarin versus DOACs for ICT. This is a retrospective review of adult patients treated with oral anticoagulation for ICT between May 2013 and December 2019. Our primary end point was complete thrombus resolution. Secondary outcomes included time to resolution of thrombus, treatment failure, and duration of therapy. Safety end points included stroke and systemic embolization (SSE) and bleeding events. A total of 123 patients were included (DOAC n = 61; warfarin n = 62). At baseline, more patients in the DOAC group had anemia 6 (10%) vs. 0 (0%), P = 0. 013 and alcohol use disorder 6 (10%) vs. 0 (0%), P = 0. 013. Complete thrombus resolution occurred in 50 (82%) and 46 (74%) patients in the DOAC and warfarin groups, respectively (P = 0. 298). There was a shorter time to thrombus resolution in the DOAC group versus the warfarin group 63 days interquartile range (IQR) 40-138 vs. 123 days IQR 86-244, P = 0. 003. There were no differences found in SSE or bleeding between the groups DOAC 11 (19%) vs. warfarin 17 (28%), P = 0. 213. For patients with an ICT, treatment with a DOAC for at least 3 months may be a comparable alternative to warfarin in safety and efficacy.