Key result
Non-vitamin K antagonist oral anticoagulants were associated with a significantly higher rate of ventricular mural thrombus resolution at 3 months compared to vitamin K antagonists (adjusted OR 2.93).
Why the study?
Characteristics, treatment practices, and clinical outcomes of patients with ventricular mural thrombus, particularly comparing NOACs and VKAs, needed to be described.
Does NOAC therapy improve thrombus resolution in patients with ventricular mural thrombus compared to VKAs?
Cohort (n=196)
No
Does NOAC therapy improve thrombus resolution in patients with ventricular mural thrombus compared to VKAs?
Odds Ratio: 2.93 (95% CI 1.51–5.66)
Absolute Event Rate: 65.6% vs 42.2%
p-value: p=0.001
NOACs are associated with a significantly higher rate of ventricular mural thrombus resolution at 3 months compared to VKAs, particularly in patients with a history of heart failure or LVEF <30%.
NOACs may be considered for VMT; observational data leaves open comparative resolution rates versus VKAs.
Background: To describe the characteristics, treatment practices, and clinical outcomes of patients with ventricular mural thrombus (VMT), with emphasis on the comparison of non-vitamin K antagonist oral anticoagulants (NOACs) and vitamin K antagonists (VKAs). Methods: We performed a retrospective cohort study between 2010 and 2019 in Fuwai Hospital, China. Patients with VMT newly treated with either NOACs or VKAs were included. The primary outcome was the incidence rate of thrombus resolution at 3 months. Results: We included 196 patients in total—68.9% (n = 135) were treated with VKAs while 31.1% (n = 61) were on NOACs. Patients with a medical history of heart failure (HF) (odds ratio (OR) 2.10, 95% confidence interval (CI) 1.17 to 3.77, p = 0.013) and a lower left ventricular ejection fraction (OR 0.36, 95% CI 0.20 to 0.65, p = 0.001) had a higher thrombus resolution. At 3 months, a significant difference was observed in the thrombus resolution between the NOACs and VKAs group with or without adjustment (OR 2.61, 95% CI 1.39 to 4.89, p = 0.003; adjusted OR 2.93, 95% CI 1.51 to 5.66, p = 0.001). Further investigation revealed that in the majority of the subgroups, individuals receiving NOAC therapy had a superior thrombus resolution than those receiving VKA therapy. Conclusions: Patients with a medical history of HF or left ventricular ejection fraction <30% experienced greater effectiveness in thrombus resolution. Additionally, the resolution of VMT with NOAC treatment was considerably higher than that with VKA therapy at 3 months, with or without adjusting for baseline variables. Clinical Trial Registration: This study was registered at ClinicalTrials.gov as NCT 05006677 on August 4th, 2021.
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Yang et al. (2023) conducted a cohort in Ventricular mural thrombus (n=196). Non-vitamin K antagonist oral anticoagulants (NOACs) vs. Vitamin K antagonists (VKAs) was evaluated on Thrombus resolution at 3 months (adjusted OR 2.93, 95% CI 1.51 to 5.66, p=0.001). Non-vitamin K antagonist oral anticoagulants were associated with a significantly higher rate of ventricular mural thrombus resolution at 3 months compared to vitamin K antagonists (adjusted OR 2.93).
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