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Safety and Effectiveness of Direct Oral Anticoagulants Versus Warfarin for Treating Left Ventricular Thrombus

John Herald1, Jesse Goitia1, Lewei Duan2

  • 1Department of Cardiology, Kaiser Permanente Los Angeles Medical Center, 1526 North Edgemont Street, 2nd Floor, Los Angeles, CA, 90027, USA.

American Journal of Cardiovascular Drugs : Drugs, Devices, and Other Interventions
|March 30, 2022
PubMed

Insights

Direct-acting oral anticoagulants (DOACs) are as effective as warfarin for treating left ventricular thrombus. DOACs also showed a lower risk of bleeding events in patients, supporting their use.

Area of Science:

  • Cardiology
  • Pharmacology
  • Clinical Medicine

Background:

  • Left ventricular thrombus poses a high risk for ischemic stroke and systemic embolization.
  • Anticoagulation is the standard treatment, but the efficacy and safety of direct-acting oral anticoagulants (DOACs) versus warfarin are not well-established.
  • This study evaluates DOACs against warfarin in patients with left ventricular thrombus within a US integrated health system.

Purpose of the Study:

  • To compare the effectiveness of direct-acting oral anticoagulants (DOACs) versus warfarin in preventing ischemic stroke and systemic embolization.
  • To assess the safety profile, specifically bleeding events, associated with DOACs compared to warfarin.
  • To provide evidence supporting treatment guidelines for left ventricular thrombus.

Main Methods:

  • A retrospective cohort study of 433 patients diagnosed with left ventricular thrombus via echocardiogram from May 2010 to April 2020.
  • Comparative effectiveness and safety analyzed using multivariable Cox proportional hazard models and inverse probability of treatment weighting.
  • Follow-up duration was a median of 3.4 years.

Main Results:

  • No significant difference in the primary effectiveness outcome (ischemic stroke, systemic embolism, transient ischemic attack) between DOACs and warfarin (aHR 0.75, P=0.21).
  • DOAC use was associated with a significantly lower risk of major bleeding events (intracranial hemorrhage, gastrointestinal bleeding, etc.) compared to warfarin (aHR 0.58, P=0.0008).
  • 30.9% of patients received DOACs, while 69.1% received warfarin.

Conclusions:

  • Direct-acting oral anticoagulants (DOACs) demonstrate comparable effectiveness to warfarin for left ventricular thrombus treatment.
  • DOACs offer a potentially safer alternative due to a reduced risk of bleeding complications.
  • Findings support the consideration and use of DOACs in managing patients with left ventricular thrombus.
Abstract

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