Research and practice in thrombosis and haemostasis · 2025
Comparison of direct oral anticoagulants and vitamin K antagonists in the treatment of left ventricular thrombi: a retrospective cohort study.
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Elbenawi Hossam, Lipps Kirsten, Heller Samuel, Liedl David A, Shields Raymond C, Casanegra Ana I, Henkin Stanislav, Rooke Thom W, Wennberg Paul W, Wysokinski Waldemar E, McBane Robert D, Houghton Damon E
Аннотация
BACKGROUND: Left ventricular thrombus (LVT) is a serious thromboembolic complication in patients with cardiomyopathies. Evidence supporting direct oral anticoagulant (DOAC) therapy in LVT is limited.
OBJECTIVES: We evaluated the effectiveness and safety of DOACs compared with vitamin K antagonists (VKAs) in patients with LVT.
METHODS: A multisite retrospective cohort study was performed, including patients with LVT diagnosed by echocardiography from 2018-2023 who were treated with either DOACs or VKAs. Primary outcome was the incidence of stroke and systemic embolism (SSE). Secondary outcomes included LVT resolution, major bleeding, and all-cause mortality.
RESULTS: A total of 182 patients with LVT met inclusion criteria, of which 70 (38.5%) were treated with only DOACs and 112 (61.5%) with only VKAs. The mean age was 66 years, and 74% of the patients were male. The median follow-up duration was 363.5 days (IQR, 139-950). No significant difference between the groups was observed in the incidence of SSE (DOAC, 5.7% vs VKA, 5.4%; P = 1.0), the incidence of LVT resolution (DOAC: 81.4% vs VKA: 87%; P = .35), the median time to LVT resolution (DOAC, 96 days vs VKA, 102 days; P = .22), or mortality (DOAC, 14.3% vs VKA, 11.6%; P = .6). However, VKAs were associated with a significantly higher incidence of major bleeding compared with DOACs (9% vs 1.4%; P = .02).
CONCLUSION: LVT treated solely with either DOACs or VKAs had similar incidences of SSE, LVT resolution, time to LVT resolution, and mortality. VKA therapy, however, was associated with a higher incidence of major bleeding events.
OBJECTIVES: We evaluated the effectiveness and safety of DOACs compared with vitamin K antagonists (VKAs) in patients with LVT.
METHODS: A multisite retrospective cohort study was performed, including patients with LVT diagnosed by echocardiography from 2018-2023 who were treated with either DOACs or VKAs. Primary outcome was the incidence of stroke and systemic embolism (SSE). Secondary outcomes included LVT resolution, major bleeding, and all-cause mortality.
RESULTS: A total of 182 patients with LVT met inclusion criteria, of which 70 (38.5%) were treated with only DOACs and 112 (61.5%) with only VKAs. The mean age was 66 years, and 74% of the patients were male. The median follow-up duration was 363.5 days (IQR, 139-950). No significant difference between the groups was observed in the incidence of SSE (DOAC, 5.7% vs VKA, 5.4%; P = 1.0), the incidence of LVT resolution (DOAC: 81.4% vs VKA: 87%; P = .35), the median time to LVT resolution (DOAC, 96 days vs VKA, 102 days; P = .22), or mortality (DOAC, 14.3% vs VKA, 11.6%; P = .6). However, VKAs were associated with a significantly higher incidence of major bleeding compared with DOACs (9% vs 1.4%; P = .02).
CONCLUSION: LVT treated solely with either DOACs or VKAs had similar incidences of SSE, LVT resolution, time to LVT resolution, and mortality. VKA therapy, however, was associated with a higher incidence of major bleeding events.