DOAC therapy resulted in significantly higher LVT resolution (66.7% vs 50%) than warfarin, with HR 2.0 (95% CI:1.07-3.73; p=0.029) and similar safety.
Do direct oral anticoagulants improve left ventricular thrombus resolution compared to warfarin in patients with recently diagnosed LVT?
In patients with left ventricular thrombus, DOAC therapy was associated with a significantly higher rate of thrombus resolution compared to warfarin, with a similar safety profile.
Absolute Event Rate: 0% vs 0%
Abstract Background and aim Left ventricular thrombus (LVT) is a frequent complication of myocardial infarction (MI) and heart failure with reduced ejection fraction (HFrEF). Once diagnosed, anticoagulation with vitamin K antagonists (VKA) up to 6-months is recommended. Clinical experience with direct oral anticoagulation (DOAC) in this setting is scarce and contradicting. Our aim is to describe the effectiveness and safety of DOAC for LVT resolution compared to warfarin. Methods Single-centre retrospective cohort study of consecutive patients with recently diagnosed LVT, either after MI or HFrEF, conducted from January 2010 to May 2024. Primary endpoint was LVT resolution whereas safety endpoints were major bleedings and thromboembolic events, both evaluated at 24months. Diagnosis and subsequent assessments were performed with echocardiography and complemented with cardiac magnetic resonance and computed tomography when appropriate. Decisions regarding anticoagulant type, dose and duration and any simultaneous antiplatelet therapy were left to physician’s discretion. Results In a cohort of 171 patients (82.5% male; mean age 59.8 ± 14.7 years), 99 received DOAC therapy, while the remaining received warfarin (Figure 1). Primary endpoint occurred in 111 patients (64.9%). At 24 months, LVT resolution occurred significantly more in patients treated with DOAC (66.7%, n=66) compared to those on warfarin (50%, n=36), with an hazard ratio (HR) of 2.0 (95% CI: 1.07–3.73; p=0.029). Thrombus tended for faster resolution on DOAC (185 days IQR: 97–377 vs. 220 days IQR: 128–378, p=0.214). DOAC remained a significant predictor of LVT resolution, independently of simultaneous antiplatelet use (HR: 3.0, 95% CI: 1.414-6.131; p=0.004). During a median nine months period (IQR 5–23) 5 (2.9%) major bleeding, 9 (5.3%) thromboembolic events, and 9 (5.3%) deaths were recorded, without significant differences between therapeutic arms. Conclusion In this cohort, DOAC use for LVT showed improved resolution with similar safety profile compared to warfarin. Further randomized clinical trials are needed to confirm these findings.
AZEVÊDO et al. (Sat,) reported a other. DOAC therapy resulted in significantly higher LVT resolution (66.7% vs 50%) than warfarin, with HR 2.0 (95% CI:1.07-3.73; p=0.029) and similar safety.