In patients with left ventricular thrombus, DOAC use was associated with a significantly lower 1-year incidence of any stroke or systemic embolism compared to warfarin (6% vs 26.6%, p=0.0001).
Observational (n=110)
No
Do direct oral anticoagulants (DOACs) prevent stroke and promote thrombus resolution as effectively as warfarin in patients with left ventricular thrombus?
In patients with left ventricular thrombus, DOACs demonstrated similar rates of stroke prevention and thrombus resolution compared to warfarin, challenging current guidelines that reserve DOACs only for those unable to tolerate warfarin.
Absolute Event Rate: 6% vs 26.6%
p-value: p=0.0001
Abstract Left ventricular thrombus (LVT) is associated with a significant risk of ischemic stroke (IS) and peripheral embolization. Societal guidelines recommend the use of warfarin, with direct oral anticoagulants (DOACs) only for patients unable to tolerate warfarin. We studied the natural history of LVT with anticoagulation (AC) with emphasis on comparing warfarin and DOAC use. In this single center study, we identified patients with a confirmed LVT. Type and duration of anticoagulation, INR levels and clinical outcomes (bleeding, ischemic stroke or peripheral embolization, and thrombus resolution) were recorded. LVT was confirmed in a total of 110 patients. Mean age was 59 + 14 years. 79% were men. Underlying etiology was chronic ischemic cardiomyopathy in 58%, non-ischemic cardiomyopathy in 23%. AC was started in 96 (87%) patients. At 1 year follow up, 11 patients (10%) had a stroke while on any AC (2 had hemorrhagic stroke and 9 had IS). Of those with IS, 7 were on warfarin (71% of those had subtherapeutic INR) and 2 patients on DOACs had IS. The 1-year risk of any stroke was 15% in warfarin group (12% risk of ischemic stroke) compared to 6% in the DOACs group ( p = 0.33). 37 (63%) patients on warfarin and 18 (53%) on DOACs had resolution of thrombus ( p = 0.85). One-year risk of stroke with LVT is high (10%) even with AC. Most patients IS on warfarin had subtherapeutic INR. There was no statistical difference in stroke risk or rate of thrombus resolution between warfarin and DOACs treated patients.
Ali et al. (Thu,) conducted a observational in Left ventricular thrombus (n=110). Direct oral anticoagulants (DOACs) vs. Warfarin was evaluated on Any stroke or systemic embolism at 1 year (p=0.0001). In patients with left ventricular thrombus, DOAC use was associated with a significantly lower 1-year incidence of any stroke or systemic embolism compared to warfarin (6% vs 26.6%, p=0.0001).