Time in therapeutic range as predictor of early left-ventricular thrombosis resolution: a retrospective cohort study
Arianna Pannunzio1, Ilaria Maria Palumbo2, Marco Paolo Donadini3
1Department of General Surgery and Surgical Specialty Paride Stefanini, Sapienza University of Rome, Rome, Italy. arianna.pannunzio@uniroma1.it.
Insights
The quality of Vitamin K antagonist (VKA) anticoagulation impacts left-ventricular thrombosis (LVT) resolution. Achieving a higher time-in-therapeutic range (TTR) is linked to earlier LVT thrombus resolution, suggesting improved anticoagulation quality aids treatment outcomes.
Area of Science:
- Cardiology
- Pharmacology
- Thrombosis Research
Background:
- Left-ventricular thrombosis (LVT) necessitates treatment with Vitamin K antagonists (VKAs) for 3-6 months to resolve thrombi and prevent cardioembolic events.
- The quality of anticoagulation, specifically time-in-therapeutic range (TTR) and international normalized ratio (INR) variability, may influence the efficacy of VKA treatment for LVT.
Purpose of the Study:
- To evaluate the association between the quality of Vitamin K antagonist (VKA) therapy and early thrombus resolution in patients with left-ventricular thrombosis (LVT).
- To determine the predictive value of time-in-therapeutic range (TTR) and INR variability for early LVT resolution.
Main Methods:
- A retrospective study involving 54 patients with LVT treated with VKAs at three Italian Anticoagulation Clinics (January 2011 - December 2023).
- Analysis focused on the primary outcome of early (up to 6 months) thrombus resolution, assessing the impact of TTR and INR variability using validated formulas.
Main Results:
- Early LVT thrombus resolution was observed in 42.6% of patients.
- A TTR of 56% demonstrated the best predictive value for early LVT resolution (AUC, 0.657).
- Patients with TTR ≥ 56% had a higher cumulative incidence of early LVT resolution (57.1%) compared to those with TTR < 56% (30.3%).
Conclusions:
- The quality of VKA anticoagulation, particularly TTR, appears to be a significant factor in achieving early LVT resolution.
- TTR evaluation shows slightly greater accuracy than INR variability in predicting early thrombus resolution in LVT patients.
Abstract:
Vitamin K antagonists (VKAs) for 3-6 months are the recommended treatment for left-ventricular thrombosis (LVT) to achieve thrombus resolution and reduce the risk of cardioembolic events. The aim of this study was to evaluate the association between quality of VKAs and early-6 months-thrombus resolution in patients with LVT. In this retrospective study, patients with LVT referred to three Italian Anticoagulation Clinics between January 2011 and December 2023 were enrolled if they received VKAs and data on LVT resolution up to 6 months of treatment were available. Primary outcome was the effect of time-in-therapeutic range and of INR variability defined according to validated formulas on early thrombus resolution. Fifty-four patients were included. Median age was 68 years and 87% were male. Overall, 41.7% and 35.4% patients had a reduced or moderately reduced left-ventricle ejection fraction and apical aneurysm. Twenty-three patients (42.6%) had early thrombus resolution. For the prediction of early LVT resolution, the best value of TTR was 56% (sensitivity, 57%; specificity, 71%; AUC, 0.657), that of INR variability, formula A was 1.65 (sensitivity, 0%; specificity, 96%; AUC, 0.478) and that of formula B 0.40 (sensitivity, 4%; specificity, 100%; AUC, 0.599). The cumulative incidence of early LVT resolution was higher in patients with TTR values ≥ 56% (57.1%; 95% confidence interval-CI 32.8-75.5%) than < 56% (30.3%; 95% CI 15.6-46.4%).The quality of VKAs anticoagulation may be a relevant driver for early LVT resolution. TTR evaluation appears to have a slightly greater accuracy compared to INR variability.
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