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Safety and Effectiveness of Direct Oral Anticoagulants Versus Warfarin for Treating Left Ventricular Thrombus

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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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Author notes

  1. John Herald and Jesse Goitia contributed equally to this work.

Authors and Affiliations

  1. Department of Cardiology, Kaiser Permanente Los Angeles Medical Center, 1526 North Edgemont Street, 2nd Floor, Los Angeles, CA, 90027, USA

    John Herald, Jesse Goitia & Ming-Sum Lee

  2. Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA

    Lewei Duan & Aiyu Chen

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  1. John Herald
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Correspondence to Ming-Sum Lee.

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Funding

No external funding was used in the preparation of this article.

Conflict of interest

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.

Ethics approval

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

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