Is Rivaroxaban a Safe Choice for Apical Thrombus in Atrial Fibrillation Patients? A Case Report

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

doi:10.1016/j.jstrokecerebrovasdis.2018.04.015

Cited by 5 publications

(2 citation statements)

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“…Until recently, data have been limited to single-arm studies and case reports. [10][11][12][13][14] RED VELVT was a multicenter retrospective study that compared DOACs with warfarin and found a significant association between DOACs and SSE. 17 This contrasts with our results and 2 recently published observational studies, which showed similar to lower risk for stroke in patients treated with a DOAC.…”

Section: Discussionmentioning

confidence: 99%

“…Factors contributing to this interest likely include the need for continuous monitoring with warfarin, potential for reduced bleeding risk with DOACs, 8 and pharmacoeconomic studies demonstrating superior cost-effectiveness of DOACs over warfarin. 9 Although convenient, DOACs require further investigation in treating LV thrombus because the literature is limited to case reports and observational studies, [10][11][12][13][14][15][16][17] and their effectiveness remains uncertain.…”

Section: Introductionmentioning

confidence: 99%

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Direct Oral Anticoagulants Versus Warfarin in the Treatment of Left Ventricular Thrombus

et al. 2020

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Background Use of direct oral anticoagulants (DOACs) for the treatment of left ventricular (LV) thrombus has gained considerable interest. Objective We aimed to evaluate if DOACs are effective in the treatment of LV thrombus compared with warfarin. Methods We evaluated the medical records of patients diagnosed with a new LV thrombus at a tertiary medical center. The primary outcome was the composite of thrombus persistence, stroke, or systemic embolism. We adjusted for potential confounders using multiple logistic regression. The safety outcome was the composite of hemorrhagic stroke or bleeding requiring blood transfusion. Results A total of 129 patients were treated with warfarin and 22, with a DOAC. In unadjusted analysis, 54.3% of patients treated with warfarin met criteria for the efficacy outcome as compared with 40.9% of patients treated with a DOAC ( P = 0.25). In adjusted analysis, no difference between groups was observed (odds ratio = 0.39; 95% CI = 0.14-1.06; P = 0.07 for DOAC vs warfarin). In all, 3.9% of patients treated with warfarin met safety criteria as compared with 4.5% of patients treated with a DOAC. A total of 8 patients in the warfarin group had a stroke or systemic embolism as compared with 0 patients in the DOAC group ( P = 0.37). Conclusion and Relevance Our data suggest that DOACs may be reasonable alternatives for treatment of LV thrombus. When added to the totality of available studies, this study demonstrates that the effectiveness of DOACs in LV thrombus remains uncertain. Randomized clinical trials are needed.

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