Efficacy of direct oral anticoagulants on left ventricular thrombus

Yıldırım, Özge Turgay; Akşıt, Ercan; Aydın, Fatih; Aydın, Ayşe

doi:10.1097/mbc.0000000000000801

Cited by 7 publications

(8 citation statements)

References 47 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Meta‐summaries of case reports of patients with LV thrombus receiving non‐vitamin K antagonists with varying numbers of patients (12–41) reported similar findings. One reported no embolic events and one episode of non‐fatal bleeding event, whilst two others reported one episode of stroke and one episode of non‐fatal bleeding 9,36,37 …”

Section: Discussionmentioning

confidence: 99%

Direct oral anticoagulants compared to vitamin K antagonist for the management of left ventricular thrombus

et al. 2020

View full text Add to dashboard Cite

Aims Left ventricular (LV) thrombus is increasingly detected in patients with and without ischaemic heart disease due to the increased availability of cardiac magnetic resonance imaging. Risk factors include anterior ST elevation myocardial infarction, delayed reperfusion therapy, and non-ischaemic cardiomyopathy with severe LV systolic dysfunction. We aimed to report the characteristics and outcomes of patients with LV thrombus treated with either vitamin K antagonist (VKA) or direct oral anticoagulants (DOAC) with a view to describing differences in efficacy, specifically, subsequent thromboembolic events, thrombus resolution, and also side effects of therapy including clinically significant bleeding. Methods and results We conducted a retrospective, observational cohort study of patients diagnosed with LV thrombus between 1 December 2012 and 30 June 2018 and treated with either DOAC or VKA. We recorded patient demographics, past medical history, prescribed medications, and baseline investigations. The primary outcomes were rates of thromboembolism and clinically significant bleeding, with secondary outcomes of thrombus resolution on repeat cardiac imaging, repeat hospitalization, and all-cause mortality. During the study period, 84 patients were diagnosed with and managed for LV thrombus. Of these, 62 received VKA and 22 DOAC including 13 prescribed rivaroxaban, eight apixaban, and one dabigatran. Most patients 75 (89%) were male with an average age of 62 ± 14 years. Ischaemic heart disease was the cause of LV impairment in 73 (87%) patients. Baseline characteristics were similar between groups at baseline. Most n = 55 (65%) were co-prescribed a single antiplatelet agent and 32 (38%) received dual-antiplatelet therapy. During an average follow-up of 3.0 ± 1.4 years, there were no statistically significant differences between VKA and DOAC in rates of stroke (2% vs. 0%, P = 0.55), other thromboemboli (2% vs. 0%, P = 0.55), or clinically significant bleeding (10% vs. 0%, P = 0.13). The average interval to cardiac imaging follow-up was 233 ± 251 days and was not different between groups (P = 0.83), and there was no difference in the rate of resolution of thrombus (76% vs. 65% P = 0.33). Rehospitalization (50% vs. 45%: P = 0.53) and all-cause mortality (10% vs. 14%; P = 0.61) were also similar. Conclusions Our data suggest that DOACs are likely to be at least as effective and safe as VKA for stroke prevention in patients with LV thrombus and, despite their lack of a licence for this indication, are therefore likely to represent a reasonable and more convenient option for this setting. The optimal timing and type of anticoagulation for LV thrombus, as well as the role of screening for high-risk patients, should be tested in prospective, randomized trials.

show abstract

Section: Discussionmentioning

confidence: 99%

Direct oral anticoagulants compared to vitamin K antagonist for the management of left ventricular thrombus

et al. 2020

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 99%

“…Our patient had three major risk factors for LVT formation: DCM, severely reduced LVEF, and an NSTE-ACS two months prior. Patients with an ejection fraction less than 40% or anteroapical wall motion dysfunction are considered high risk for LVT formation and should receive anticoagulation for at least three months [ 5 ]. Our patient was at high risk for LVT formation; however, she was non-compliant with home medications and therefore was not prescribed anticoagulation for prophylaxis.…”

Section: Discussionmentioning

confidence: 99%

“…Our patient was at high risk for LVT formation; however, she was non-compliant with home medications and therefore was not prescribed anticoagulation for prophylaxis. According to current guidelines, patients with a LVT should receive anticoagulation for at least three months [ 5 , 6 ] and our patient was discharged with apixaban.…”

Section: Discussionmentioning

confidence: 99%

“…Early identification of a LVT is important because of an increased risk of systemic embolization, which occurs at an incidence of 11%, mostly within 3-4 months of thrombus detection [ 5 ]. There is limited data that suggests that the newer direct oral anticoagulants (DOACs) are good choices for LVT; however, guidelines still recommend warfarin [ 5 , 6 ]. Our patient had a significant history of medication non-compliance and leaving the hospital against medical advice, and therefore we chose apixaban.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Left Ventricular Thrombus Formation in a Young Female With a Severely Reduced Left Ventricular Ejection Fraction and a Recent Non-ST Segment Elevation-Acute Coronary Syndrome

Patel

Kassir

Patel

et al. 2021

Cureus

View full text Add to dashboard Cite

A 30-year-old female with a past medical history of heart failure with reduced ejection fraction (HFrEF of 20%), non-ST segment elevation-acute coronary syndrome (NSTE-ACS), and polysubstance abuse (heavy alcohol and methamphetamine use) was admitted for a heart failure exacerbation. Electrocardiogram and troponin levels were negative. Pro brain natriuretic peptide was elevated at 4,152 pg/mL. The patient was restarted on guideline-directed HFrEF therapy and continued to improve. Two days after presentation, the patient was transferred to the intensive care unit for severe alcohol withdrawal, requiring intravenous phenobarbital and dexmedetomidine. After her withdrawal symptoms resolved, she complained of rightsided weakness and stroke-like symptoms. Brain magnetic resonance imaging (MRI) and computed tomography (CT) were both negative. Echocardiography revealed an ejection fraction of 20% and a severely dilated left ventricle with a 2.1 x 1.2 cm apical density, suggestive of a thrombus, and the patient was started on apixaban. Echocardiography two months prior to this admission revealed an ejection fraction of 20%, but there was no evidence of a thrombus. Our patient had three major risk factors for left ventricular thrombus (LVT) formation: severely reduced left ventricular ejection fraction (LVEF), dilated cardiomyopathy (DCM), and a recent NSTE-ACS two months prior. This case highlights the importance of anticoagulation in patients at high risk for LVT formation and emphasizes the DCM may be seen in younger patients with heavy alcohol and amphetamine use.

show abstract

Effect of direct oral anticoagulants versus vitamin K antagonists or warfarin in patients with left ventricular thrombus outcomes: A systematic review and meta-analysis

Ferreira¹,

Lopes²,

Augusto³

et al. 2023

Revista Portuguesa de Cardiologia

View full text Add to dashboard Cite

Efficacy of direct oral anticoagulants on left ventricular thrombus

Cited by 7 publications

References 47 publications

Direct oral anticoagulants compared to vitamin K antagonist for the management of left ventricular thrombus

Direct oral anticoagulants compared to vitamin K antagonist for the management of left ventricular thrombus

Left Ventricular Thrombus Formation in a Young Female With a Severely Reduced Left Ventricular Ejection Fraction and a Recent Non-ST Segment Elevation-Acute Coronary Syndrome

Effect of direct oral anticoagulants versus vitamin K antagonists or warfarin in patients with left ventricular thrombus outcomes: A systematic review and meta-analysis

Contact Info

Product

Resources

About