Abstract
Background
Patients with left ventricular thrombus are at high risk for ischemic stroke and systemic embolization. The mainstay of treatment is anticoagulation, but it remains unclear if direct-acting oral anticoagulants (DOACs) are a safe and effective treatment strategy compared to warfarin. We conducted a population-based retrospective cohort study to evaluate the effectiveness and safety of DOACs compared to warfarin in an integrated health system in the United States.
Methods
Consecutive patients with left ventricular thrombus on transthoracic echocardiogram from May 2010 to April 2020 were identified. Comparative effectiveness and safety of DOACs and warfarin were evaluated using multivariable Cox proportional hazard models and inverse probability of treatment weighting.
Results
Among 433 patients with left ventricular thrombus, 134 (30.9%) were treated with DOACs and 299 (69.1%) were treated with warfarin. Patients were followed for a median of 3.4 years. For the primary effectiveness outcome of ischemic stroke, systemic embolism, and transient ischemic attack, no significant difference was observed between use of DOACs compared to warfarin (adjusted hazard ratio [HR] of 0.75, 95% confidence interval [CI] 0.48–1.18, p = 0.21). For the primary safety outcome of intracranial hemorrhage, gastrointestinal bleeding, and other bleed requiring hospitalization, DOAC usage was associated with a lower risk of bleeding (HR 0.58, 95% CI 0.39–0.87, p = 0.0008).
Conclusions
In this diverse population-based cohort of patients, DOAC treatment for left ventricular thrombus appears to be as safe and effective as warfarin treatment. These findings support the use of DOACs for patients with left ventricular thrombus.
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John Herald, Jesse Goitia, Lewei Duan, Aiyu Chen, and Ming-Sum Lee declare that they have no potential conflicts of interest that might be relevant to the contents of this article.
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The present study was approved by the Kaiser Permanente Southern California Institutional Review Board.
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Author contributions
JH: investigation, validation, writing; JG: conceptualization, investigation, data curation, methodology, reviewing; LD: data curation, analysis, reviewing, methodology; AC: data curation, analysis, reviewing; MSL: conceptualization, investigation, methodology, writing, reviewing, editing.
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Herald, J., Goitia, J., Duan, L. et al. Safety and Effectiveness of Direct Oral Anticoagulants Versus Warfarin for Treating Left Ventricular Thrombus. Am J Cardiovasc Drugs 22, 437–444 (2022). https://doi.org/10.1007/s40256-022-00533-w
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DOI: https://doi.org/10.1007/s40256-022-00533-w