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

Introduction: 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.

Methods: 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.

Results: 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).

Conclusion: In our retrospective analysis, DOACs had similar efficacy and safety when compared to warfarin in the treatment of LV thrombi.