Evaluation of Direct Oral Anticoagulants Versus Warfarin for Intracardiac Thromboses

Area of Science:

• Cardiology
• Pharmacology
• Internal Medicine

Background:

• Intracardiac thrombus (ICT) is a frequent complication of cardiovascular diseases.
• Warfarin is the guideline-recommended treatment, but its use predates direct oral anticoagulants (DOACs).
• Current prescribing patterns and comparative efficacy/safety of warfarin versus DOACs for ICT are not well-established.

Purpose of the Study:

• To evaluate current institutional prescribing patterns for intracardiac thrombus (ICT) treatment.
• To compare the efficacy and safety of warfarin versus direct oral anticoagulants (DOACs) in patients with ICT.
• To assess outcomes including thrombus resolution, time to resolution, treatment failure, and safety events.

Main Methods:

• Retrospective review of adult patients treated for ICT between May 2013 and December 2019.
• Comparison of complete thrombus resolution, time to resolution, treatment failure, and duration of therapy.
• Evaluation of safety endpoints: stroke, systemic embolization (SSE), and bleeding events.

Main Results:

• 123 patients were included: 61 on DOACs and 62 on warfarin.
• Complete thrombus resolution rates were similar: 82% for DOACs vs. 74% for warfarin (P=0.298).
• DOACs showed a significantly shorter time to thrombus resolution (63 days vs. 123 days, P=0.003).
• No significant differences in stroke, systemic embolization, or bleeding events were observed between groups.
• Baseline differences included higher rates of anemia and alcohol use disorder in the DOAC group.

Conclusions:

• Direct oral anticoagulants (DOACs) demonstrate comparable efficacy and safety to warfarin for intracardiac thrombus (ICT) treatment.
• DOACs may offer a faster resolution time for ICT compared to warfarin.
• Treatment with DOACs for at least 3 months appears to be a viable alternative to warfarin for ICT management.