Clinical outcomes of direct oral anticoagulants versus warfarin for ischemic stroke caused by left ventricular thrombus: A retrospective one-center study

OBJECTIVE: LVT is a leading etiology of cardioembolic stroke, and appropriate anticoagulation therapy is essential. However, the choice of anticoagulant in LVT patients remains based on the individual patient and physician. The objective of this study is to evaluate the relative clinical outcomes of warfarin and direct oral anticoagulant (DOAC) agents for patients with ischemic stroke due to left ventricular thrombus (LVT). METHODS: This retrospective observational study included 48 adult patients treated for ischemic stroke secondary to LVT at our institution between 9/2017 and 12/2024. Patients were included if they were anticoagulated with warfarin or a DOAC and had follow-up cardiac imaging to assess thrombus resolution within 6 months of LVT diagnosis. We evaluated rates of LVT resolution and complications by anticoagulant usage. RESULTS: By 6 months, 79% of patients achieved thrombus resolution. Five patients were switched from warfarin to a DOAC. There was no statistically significant difference in thrombus resolution rates between warfarin, Apixaban, and Rivaroxaban use at initial diagnosis (p = 0.6). However, thrombus resolution was associated with DOAC use at 6 month follow-up (p = 0.07). Warfarin use trended towards a higher rate of complications, although the overall number of complications was too small to reach statistical significance. CONCLUSIONS: These findings suggest that DOACs are non-inferior to warfarin for resolution of LVT by 6 months. Warfarin may be associated with greater complication risk. These factors should be taken into consideration when selecting an anticoagulant agent for patients diagnosed with LVT.