Why the study?
DOACs have displaced VKAs as first-line therapy for multiple thrombotic disorders, but evidence supporting their efficacy over VKAs for intracardiac thrombosis remains limited.
Do DOACs improve thrombus resolution in patients with left atrial appendage thrombi?
Do DOACs improve thrombus resolution in patients with left atrial appendage thrombi?
This case series suggests that DOACs at venous thromboembolic doses are effective for resolving left atrial appendage thrombi without complications.
May support DOAC use for intracardiac thrombosis in select cases; leaves open need for RCTs to confirm efficacy versus VKAs.
BACKGROUND: Vitamin K antagonists (VKAs) have been regarded as the therapy of choice for intracardiac thrombosis for decades based mostly on observational data. The advent of direct oral anticoagulants (DOACs) has displaced VKAs as the first-line therapy for multiple thrombotic disorders but not for intracardiac thrombosis. Although limited, there is growing evidence that DOACs are effective for intracardiac thrombosis and some data suggest that thrombus resolution might be superior to that with warfarin. CASE SUMMARY: Here, we present a series of six patients with left atrial appendage thrombi were treated with a venous thromboembolic dose of DOACs with resolution within 2-6 months with no reported complications. DISCUSSION: This case series adds to the accumulating evidence supporting the efficacy of DOACs in the treatment of intracardiac thrombi.
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Al‐Sadawi et al. (2020) studied this question.
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