- In patients with left ventricular (LV) thrombus, direct oral anticoagulants (DOACs) are likely to be as effective and safe as vitamin K antagonist (VKA) for stroke prevention and, despite their lack of a licence for this indication, are therefore likely to represent a reasonable and more convenient option for this setting.
Why this matters
- Findings warrant future prospective, randomised trials to explore the optimal timing and type of anticoagulation for LV thrombus, as well as the role of screening for high-risk patients.
- This retrospective, observational cohort study included 84 patients diagnosed with LV thrombus; 62 received VKA (warfarin) and 22 DOAC including 13 prescribed rivaroxaban, eight apixaban, and one dabigatran.
- Primary outcome: thromboembolic events and clinically significant bleeding.
- Secondary outcomes: thrombus resolution on repeat cardiac imaging, all-cause mortality, and repeat hospitalisation.
- Funding: None disclosed.
- Overall, 55 patients (65%) were co-prescribed a single antiplatelet agent and 32 (38%) received dual-antiplatelet therapy.
- During an average follow-up of 3.0±1.4 years, no statistically significant differences were observed between VKA and DOACs in:
- rates of stroke (2% vs 0%; P=.55);
- other thromboemboli (2% vs 0%; P=.55); and
- clinically significant bleeding (10% vs 0%; P=.13).
- The mean duration between diagnosis and repeat imaging was 233 ± 251 days with no difference between groups (P=.83).
- The rate of resolution of thrombus (76% vs 65%; P=.33), rehospitalisation (50% vs 45%; P=.53), and all-cause mortality (10% vs 14%; P=.61) did not differ between groups.
- Retrospective design.
- Small sample size.