Off-label use of direct oral anticoagulants compared with warfarin for left ventricular thrombi after myocardial infarction

Left ventricular thrombus (LVT) mirrors a rare but dreaded complication during the acute phase of acute myocardial infarction (AMI). Incidence rates differ among observational studies from 1.6% to 39%.1 Optimal pharmacological therapy to ensure thrombus resolution without risking major adverse events remains a challenging approach in affected individuals. While dual antiplatelet therapy (DAPT) after stent implantation is mandatory for the reduction of atherothrombotic events, oral anticoagulation is also indicated in case of present LVT formation. Triple antithrombotic therapy (TAT) for LVT after AMI confers an increased risk for major bleeding events and adverse patient outcome, since current guidelines only recommend vitamin K antagonists (VKAs) for thrombus resolution.2 Especially, the narrow therapeutic window of international normalized ration (INR) values poses a major concern in VKA therapy, necessitating frequent monitoring and varying time in therapeutic range (TTR). Considering lower rates of intracranial haemorrhage and bleeding events, direct oral anticoagulants (DOACs)...