Direct oral anticoagulants vs. warfarin for left ventricular thrombus

Area of Science:

• Cardiology
• Pharmacology
• Clinical Research

Background:

• Left ventricular (LV) thrombus is associated with significant mortality and embolic risk.
• Warfarin has been the traditional treatment, but comparative data with direct oral anticoagulants (DOACs) is limited.

Purpose of the Study:

• To compare the real-world, risk-adjusted outcomes of DOACs versus warfarin in patients diagnosed with LV thrombus.
• To evaluate the effectiveness and safety profiles of these anticoagulant therapies in this specific patient population.

Main Methods:

• Retrospective cohort analysis of adult patients with echocardiographically confirmed LV thrombus from 2016-2022.
• Propensity score matching (1:1) was employed to balance baseline characteristics between DOAC and warfarin groups.
• Exclusion criteria included atrial fibrillation, prior venous thromboembolism, and mechanical valves.

Main Results:

• No significant difference in the composite outcome of all-cause mortality and stroke/transient ischemic attack at 30 days and 1 year between DOAC and warfarin groups.
• Major bleeding rates were comparable between the two treatment groups at both 30 days and 1 year.
• Approximately 81% of patients achieved LV thrombus resolution at 6 months, with no significant difference observed based on the anticoagulant used.

Conclusions:

• Direct oral anticoagulants (DOACs) and warfarin demonstrate comparable efficacy and safety in managing left ventricular thrombus.
• DOACs represent a reasonable and effective alternative to warfarin for patients with LV thrombus.