Do direct oral anticoagulants (DOACs) reduce stroke and systemic embolism compared to vitamin K antagonists (VKAs) in patients with left ventricular thrombus?
DOACs offer a similar efficacy profile to VKAs for left ventricular thrombus resolution and stroke prevention, but with a lower risk of major bleeding.
Background: Left ventricular thrombus (LVT) is a serious thromboembolic complication in patients with cardiomyopathies. Evidence supporting direct oral anticoagulant (DOAC) therapy in LVT is limited. Objectives: We evaluated the effectiveness and safety of DOACs compared with vitamin K antagonists (VKAs) in patients with LVT. Methods: A multisite retrospective cohort study was performed, including patients with LVT diagnosed by echocardiography from 2018-2023 who were treated with either DOACs or VKAs. Primary outcome was the incidence of stroke and systemic embolism (SSE). Secondary outcomes included LVT resolution, major bleeding, and all-cause mortality. Results: = .02). Conclusion: LVT treated solely with either DOACs or VKAs had similar incidences of SSE, LVT resolution, time to LVT resolution, and mortality. VKA therapy, however, was associated with a higher incidence of major bleeding events.
Elbenawi et al. (Thu,) studied this question.