A meta-summary of case reports of non-vitamin K antagonist oral anticoagulant use in patients with left ventricular thrombus
- 120 Downloads
Left ventricular (LV) thrombus is commonly seen in patients with extensive anterior ST-elevation myocardial infarction. The standard of care for LV thrombus is anticoagulation with warfarin. However, there has been an increasing trend of case reports using non-vitamin K antagonist oral anticoagulants (NOAC) for the treatment of LV thrombus. This study aimed to perform a meta-summary of the literature to characterise and evaluate the safety and feasibility of using NOAC in patients with LV thrombus. We searched for articles published in four electronic databases: PubMed, EMBASE, Scopus and Google Scholar using an appropriate keyword/MeSH term search strategy. Twenty-four studies comprising 36 patients were included in the analysis. Rivaroxaban was used in majority of patients (47.2%), whilst Apixaban and Dabigatran were prescribed in 25.0% and 27.8% of patients respectively. The most commonly associated risk factor found was post-acute myocardial infarction in 15 patients (41.7%). LV thrombus resolution was met by most patients (87.9%), and the median duration of treatment to resolution was 30.0 days (IQR = 22.5–47.0). One non-fatal bleeding event (3.0%) and no embolic events were reported. The use of NOAC may have a role in the treatment of LV thrombus in selected patients. Further randomized controlled trials are needed to evaluate this treatment strategy.
KeywordsAnticoagulation Left ventricular thrombus NOAC Thrombosis
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
Research involving human and animal rights
This article does not contain any studies with human participants or animals performed by any of the authors.
- 5.Guyatt GH, Akl EA, Crowther M, Gutterman DD, Schuünemann HJ (2012) Executive summary: antithrombotic therapy and prevention of thrombosis: American College of Chest Physicians evidence-based clinical practice guidelines. Chest J 141:7S–47SGoogle Scholar
- 7.Ruff CT, Giugliano RP, Braunwald E, Hoffman EB, Deenadayalu N, Ezekowitz MD, Camm AJ, Weitz JI, Lewis BS, Parkhomenko A, Yamashita T (2014) Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trials. Lancet 383:955–962CrossRefPubMedGoogle Scholar
- 10.Devereaux PJ, Fahey T, Anderson DR, Gardner MJ, Putnam W, Flowerdew GJ, Brownell BF, Nagpal S, Cox JL (2001) Differences between perspectives of physicians and patients on anticoagulation in patients with atrial fibrillation: observational study Commentary: varied preferences reflect the reality of clinical practice. BMJ 323:1218CrossRefPubMedPubMedCentralGoogle Scholar