Back to Search Start Over

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

Authors :
Herald J
Goitia J
Duan L
Chen A
Lee MS
Source :
American journal of cardiovascular drugs : drugs, devices, and other interventions [Am J Cardiovasc Drugs] 2022 Jul; Vol. 22 (4), pp. 437-444. Date of Electronic Publication: 2022 Mar 29.
Publication Year :
2022

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.<br />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.<br />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).<br />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.<br /> (© 2022. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Details

Language :
English
ISSN :
1179-187X
Volume :
22
Issue :
4
Database :
MEDLINE
Journal :
American journal of cardiovascular drugs : drugs, devices, and other interventions
Publication Type :
Academic Journal
Accession number :
35352321
Full Text :
https://doi.org/10.1007/s40256-022-00533-w