Direct Oral Anticoagulants versus Warfarin for the Treatment of Left Ventricular Thrombus: A Multicenter Retrospective Observational Study

Abdullah Al-Abcha; Shannon Clay; Ling Wang; Rohan Madhu Prasad; Mohammad Fahad Salam; Shaurya Srivastava; Manel Boumegouas; George S Abela; Yehia Saleh; Essa M Essa

doi:10.1016/j.amjcard.2024.11.026

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Direct Oral Anticoagulants versus Warfarin for the Treatment of Left Ventricular Thrombus: A Multicenter Retrospective Observational Study

Journal article

Peer reviewed

Direct Oral Anticoagulants versus Warfarin for the Treatment of Left Ventricular Thrombus: A Multicenter Retrospective Observational Study

Abdullah Al-Abcha, Shannon Clay, Ling Wang, Rohan Madhu Prasad, Mohammad Fahad Salam, Shaurya Srivastava, Manel Boumegouas, George S Abela, Yehia Saleh and Essa M Essa

The American journal of cardiology, Vol.238, pp.21-24

03/01/2025

DOI: 10.1016/j.amjcard.2024.11.026

PMID: 39586485

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Abstract

Vitamin K antagonists remain the mainstay of therapy in patients with left ventricular thrombus (LVT) because the efficacy of direct oral anticoagulants (DOACs) is not well established. We performed a multicenter retrospective analysis of adults admitted between January 2015 and December 2021 and diagnosed with LV thrombus to compare the safety and efficacy of Warfarin vs DOACs. The primary outcome was thrombus resolution. Secondary outcomes included all-cause mortality, bleeding events and stroke or systemic embolism. A total of 189 patients were included. The rate of thrombus resolution was similar in patients with LVT treated with DOACs when compared to those treated with warfarin (DOACs 73.9%vs warfarin 68.5%, p=0.489). Additionally all-cause mortality (DOACs 13.04% vs warfarin 9.79%, p=0.583), bleeding events (DOACs 19.57% vs warfarin 13.99%, p=0.361), and SSE (DOACs 10.87% vs warfarin 15.38%, p=0.446) were all similar in the two groups. In the propensity matched group, 90 patients were included. Multivariate analysis showed no significant difference of using warfarin or DOACs on thrombus resolution (OR 0.94, 95% CI 0.858-1.029, p=0.18), all-cause mortality (OR 1.032, 95% CI 0.906-1.176, p=0.6354), bleeding events (OR 1.694, 95% CI 0.168-17.097, p=0.655), or SSE (OR 1.947, 95% CI 0.087-4.756, p=0.6747). In our retrospective analysis, DOACs had similar efficacy and safety when compared to warfarin in the treatment of LV thrombi.

Left ventriuclar thrombi

Warfarin

Direct oral anticoagulants

Details

Title: Subtitle: Direct Oral Anticoagulants versus Warfarin for the Treatment of Left Ventricular Thrombus: A Multicenter Retrospective Observational Study
Creators: Abdullah Al-Abcha - Mayo Clinic
Shannon Clay - Mount Carmel Health
Ling Wang - Michigan State University
Rohan Madhu Prasad - Sparrow Hospital
Mohammad Fahad Salam - Michigan State University
Shaurya Srivastava - Sparrow Hospital
Manel Boumegouas - Michigan State University
George S Abela - Michigan State University
Yehia Saleh - University of Iowa
Essa M Essa - Mount Carmel Health
Resource Type: Journal article
Publication Details: The American journal of cardiology, Vol.238, pp.21-24
Publisher: EXCERPTA MEDICA INC-ELSEVIER SCIENCE INC
DOI: 10.1016/j.amjcard.2024.11.026
PMID: 39586485
ISSN: 0002-9149
eISSN: 1879-1913
Language: English
Electronic publication date: 11/23/2024
Date published: 03/01/2025
Academic Unit: Internal Medicine
Record Identifier: 9984757156902771

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