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Published on: February 28, 2012

DOACs vs Warfarin for Post-myocardial Infarction Left Ventricular Thrombus: A GRADE-assessed Meta-Analysis With Trial

Ahmed Elbataa1, Ameer Awashra2, Ahmed Elazab3

  • 1Faculty of Medicine, Al-Azhar University, Cairo, Egypt.

Clinical and Applied Thrombosis/Hemostasis : Official Journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis
|July 13, 2026
PubMed

Insights

Direct oral anticoagulants (DOACs) show similar efficacy and safety to warfarin for resolving left ventricular thrombus (LVT) after myocardial infarction (MI). Further research is needed to confirm these findings in larger trials.

Area of Science:

  • Cardiology
  • Pharmacology
  • Clinical Trials

Background:

  • Current guidelines recommend comparing direct oral anticoagulants (DOACs) and warfarin for post-myocardial infarction (MI) left ventricular thrombus (LVT).
  • DOACs offer convenience with minimal monitoring, but their effectiveness in LVT resolution requires further investigation.
  • Existing studies provide limited data on DOAC efficacy and safety in this specific patient population.

Purpose of the Study:

  • To evaluate the efficacy and safety of DOACs compared to warfarin in patients with post-MI LVT.
  • To assess LVT resolution rates and compare risks of death, stroke, and major bleeding between DOAC and warfarin groups.
  • To synthesize current evidence on anticoagulant therapy for LVT management post-MI.

Main Methods:

  • A systematic literature search was conducted across major databases (Medline/PubMed, Scopus, Web of Science, Cochrane Library) up to August 2025.
  • Included four randomized controlled trials (RCTs) involving 396 patients (240 on DOACs, 156 on warfarin).
  • Primary outcome was LVT resolution; secondary outcomes included all-cause death, stroke, and major bleeding.

Main Results:

  • Left ventricular thrombus (LVT) resolution rates were comparable: 90.0% with DOACs versus 86.5% with warfarin (p=0.84).
  • Subgroup analyses indicated similar outcomes for rivaroxaban and apixaban compared to warfarin.
  • Rates of stroke, all-cause mortality, and major bleeding did not significantly differ between the DOAC and warfarin groups.

Conclusions:

  • Direct oral anticoagulants (DOACs) demonstrate comparable efficacy and safety to warfarin for managing left ventricular thrombus (LVT) after myocardial infarction (MI).
  • Current evidence suggests similar rates of thrombus resolution and complications between DOACs and warfarin.
  • Further large-scale randomized trials are necessary to confirm these findings due to the underpowered nature of existing studies.

Keywords:
direct oral anticoagulantsleft ventricular thrombusmeta-analysismyocardial infarctionwarfarin

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