Direct oral anticoagulants versus Vitamin K antagonists for left ventricular thrombus management

BACKGROUND: This study compared the rates of intracranial hemorrhage (ICH), ischemic stroke, transient ischemic attack (TIA), and major bleeding events between patients receiving direct oral anticoagulants (DOACs) or vitamin K antagonists (VKAs) for left ventricular thrombus (LVT) management. METHODS: In this retrospective analysis of claims data, 3152 patients receiving treatment for LVT were identified. Two cohorts were exactly matched on age, sex, and pertinent comorbidities. The primary outcomes were rates of ICH, ischemic stroke, TIA, and major bleeding events between the two groups at 12 months and 24 months. Differences were assessed using the Kaplan-Meier method. Data was analyzed using R (Version 4.1, R Foundation, Vienna, Austria). RESULTS: 336 patients were compared after the match. The majority were aged between 50-75 (76.2%), were male (80.1%), and had hypertension (77.38%) and hyperlipidemia (66.07%). At 12 months, there were no differences in the rates of ICH (3/168 vs. 2/168, p = 0.7), ischemic stroke (22/168 vs. 15/168, p = 0.2), TIA (9/168 vs 3/168, p = 0.08), or major bleeding events (25/168 vs 35/168, p = 0.1) between DOAC and VKA groups, respectively. Similarly, there were no differences at 24 months in ICH (4/168 vs. 4/168, p = 1), ischemic stroke (26/168 vs. 26/168, p = 0.9), TIA (10/168 vs 4/168, p = 0.1), and major bleeding events (36/168 vs 45/168, p = 0.2) between DOAC and VKA groups, respectively. CONCLUSIONS: DOACs appear to be safe alternatives to VKAs, substantiating their use for LVT management. Further evaluation is nevertheless warranted.