What is the clinical evidence from this study?

Study design: Systematic Review. Population: Left ventricular thrombus (n=52). Intervention: Direct oral anticoagulants (DOACs). Primary outcome: Thrombus resolution.

March 14, 2020

Direct Oral Anticoagulants for the Treatment of Left Ventricular Thrombus—A New Indication? A Meta-summary of Case Reports

Key Result

Direct oral anticoagulants for the treatment of left ventricular thrombus resulted in thrombus resolution in 92% of patients (45 of 49) at a median of 32 days.

Study Design

Type

Systematic Review (n=52)

Structured PICO

Do direct oral anticoagulants (DOACs) effectively resolve left ventricular thrombus?

Population

52 patients with left ventricular thrombus (LVT) extrapolated from 34 case reports

Intervention

Direct oral anticoagulants (DOACs), most commonly rivaroxaban followed by apixaban

Outcome

Thrombus resolutionsurrogate

DOACs appear to be a reasonable and effective option for the treatment of left ventricular thrombus, with a 92% resolution rate in published case reports, providing rationale for future randomized trials.

Abstract

Left ventricular thrombus (LVT) can be a consequence of cardiac diseases such as heart failure with reduced ejection fraction and acute myocardial infarction. Currently, the guidelines recommend the use of warfarin for the treatment of this condition. However, there are increasing reports of patients with LVTs being treated with direct oral anticoagulants (DOACs), for several reasons. We set out to review the available literature to assess the safety and the efficacy of this approach. We analyzed 52 cases, extrapolated by 34 papers contained in literature, focusing on the characteristics of patients, treatment, outcome, and follow-up. Rivaroxaban was the most commonly used DOAC, followed by apixaban. The diagnosis of LVT and the follow-up were mainly performed by transthoracic echocardiography. The thrombus resolved in 45 patients (92%) of 49 (there are no data available regarding the outcome of 3 patients) and failed to resolve in 4 patients treated with DOACs. The resolution occurred in a median of 32 days. DOACs are shown to be a reasonable and valid option for the treatment of LVT. Our study provides a rationale for a prospective randomized controlled trial.

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