Left ventricular mural thrombus despite treatment with dabigatran and clopidogrel

Fredgart, Maise Høigaard; Gill, Sabine

doi:10.1136/bcr-2017-223899

Cited by 2 publications

(3 citation statements)

References 16 publications

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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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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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“…One hypothesis postulated is that dabigatran binds thrombin in a one-to-one molecular ratio, while one factor Xa leads to the generation of 1000 thrombin molecules, making factor Xa inhibition more attractive. Few cases of LV thrombi on dabigatran therapy have emerged in the literature [ 50 , 51 ]. The use of dabigatran for anticoagulation in mechanical heart valves was also unsuccessful in a RE-ALIGN study.…”

Section: Doacs In LV Thrombus—the Clinical Experiencementioning

confidence: 99%

Anticoagulation for Left Ventricle Thrombus—Case Series and Literature Review for Use of Direct Oral Anticoagulants

Pradhan

Bhandari

Vishwakarma

et al. 2023

JCDD

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Left ventricular thrombus is a known complication following acute myocardial infarction that can lead to systemic thromboembolism. To obviate the risk of thromboembolism, the patient needs anticoagulation in addition to dual antiplatelet therapy. However, combining antiplatelets with anticoagulants substantially increases the bleeding risk. Traditionally, vitamin K antagonists (VKAs) have been the sheet anchor for anticoagulation in this scenario. The use of direct oral anticoagulants has significantly attenuated the bleeding risk associated with anticoagulation for atrial fibrillation and venous thromboembolism. Furthermore, in patients with atrial fibrillation undergoing percutaneous coronary intervention, the use of direct oral anticoagulants (DOACs) in conjunction with antiplatelets has been found to be noninferior in reducing ischemic events while significantly attenuating the bleeding compared with VKA. After initial case reports, multiple observational and nonrandomized studies have now safely and effectively utilized direct oral anticoagulants for anticoagulation in left ventricular thrombus. Here, we report a series of two cases presenting with left ventricular thrombus following acute myocardial infarction. In this case series, we try to address the issues concerning the choice and duration of anticoagulation in the case of postinfarct left ventricular thrombus. Pending the results of large randomized control trials, the judicious use of direct oral anticoagulant is warranted when taking into consideration the ischemic and bleeding profile in an individualized approach.

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Left ventricular mural thrombus despite treatment with dabigatran and clopidogrel

Cited by 2 publications

References 16 publications

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

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

Anticoagulation for Left Ventricle Thrombus—Case Series and Literature Review for Use of Direct Oral Anticoagulants

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