Treatment of Left Ventricular Thrombus Using Warfarin Versus Direct Oral Anticoagulants Following Anterior Myocardial Infarction

Jaidka, Atul; Tong, Zhu; Lavi, Shahar; Johri, Amer M.

doi:10.1016/j.cjca.2018.07.194

Cited by 24 publications

(61 citation statements)

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“…After systematic review, a total of 6 studies (2 fully published papers and 3 published abstracts), in addition to our current study were included (n = 408 for DOACs; n = 1207 for VKA). 30 -34 Overall, there was no significant differences between patients treated with DOACs versus VKAs for LVT with respect to odds for unresolved thrombus (OR 0.61, 95% CI 0.26,1.41), embolic events (OR 1.24, 95% CI 0.90,1.69), or bleeding events (OR 1.13, 95% CI 0.74,1.72) (Figure 2). No significant heterogeneity was noted.…”

Section: Resultsmentioning

confidence: 98%

Direct Oral Anticoagulants in the Treatment of Left Ventricular Thrombus: A Retrospective, Multicenter Study and Meta-Analysis of Existing Data

Cochran

Jia

Kaczmarek

et al. 2020

J Cardiovasc Pharmacol Ther

109

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Aim: To compare the safety and efficacy of direct oral anticoagulants (DOAC) relative to vitamin K antagonists (VKA) for the treatment of left ventricular thrombus (LVT). Methods: This retrospective study enrolled patients diagnosed with LVT from 2014-2017. Patient characteristics and outcomes within 12 months of LVT diagnosis were recorded and analyzed. A meta-analysis was also performed by pooling our results with existing data in literature. Results: 14 DOAC and 59 VKA patients were included. Baseline demographic and clinical characteristics were similar except for age. Although more strokes within 12 months occurred in VKA (15%) than in DOAC (0%) patients, this was not statistically significant (p = 0.189). There were no significant differences in outcomes between patients on DOAC and VKA for acute coronary syndrome (ACS) (7%, vs 3.4%, p = .477), LVT resolution (86% vs 76%, p = .499) or bleeding (14% vs 14%, p = 1) within 12 months. The meta-analysis included 6 studies (n = 408 for DOACs; n = 1207 for VKA). There were no significant differences between DOACs versus VKAs with respect to odds for unresolved thrombus (OR 0.61, 95% CI 0.26,1.41), embolic events (OR 1.24, 95% CI 0.90,1.69), embolic events and death (OR 1.10, 95% CI 0.84,1.45) or bleeding events (OR 1.13, 95% CI 0.74,1.72). Conclusions: Our study and meta-analysis suggest similar efficacy and safety of DOACs in the treatment of LVT compared to VKA. These findings underscore the need for a randomized controlled trial.

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Section: Resultsmentioning

confidence: 98%

Direct Oral Anticoagulants in the Treatment of Left Ventricular Thrombus: A Retrospective, Multicenter Study and Meta-Analysis of Existing Data

Cochran

Jia

Kaczmarek

et al. 2020

J Cardiovasc Pharmacol Ther

109

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“…A single-centre retrospective study including 49 patients with LV thrombus due to anterior ST-elevation myocardial infarction found no significant difference in rates of thromboembolism, major bleeding, or thrombus resolution between VKA and DOACs concluding that DOAC appeared to be safe for such patients. 34 In another retrospective analysis of 98 patients with LV thrombus, 36% of which were treated with DOAC; there were no differences in rates of stroke or systemic embolization, but this study did not report rates of bleeding or thrombus resolution. 35 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.…”

Section: Direct Oral Anticoagulant For the Treatment Of Left Ventricumentioning

confidence: 83%

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

et al. 2020

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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.

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“…Seven studies had reported their rates of thrombus resolution [12][13][14][25][26][27][28] The odds of thrombus resolution in warfarin group was 11% higher compared to DOACs group, with a pooled odds ratio of 1.11 (95% CI 0.51-2.39) but it did not reach a statistical significance (p = 0.76), as shown in Fig. 4.…”

Section: Thrombus Resolutionmentioning

confidence: 97%

“…We identified a total of 8 studies [12][13][14][24][25][26][27][28] with a pooled sample size of 1955 patients comparing the therapeutic effectiveness and risk profile of warfarin vs DOACs in patients with LVT. The mean age of patients was 61 years and 59.7 years in warfarin and DOACs group, respectively.…”

Section: Baseline Demographic Findingsmentioning

confidence: 99%

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Warfarin versus direct oral anticoagulants for treating left ventricular thrombus: a systematic review and meta-analysis

et al. 2021

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Background Left ventricular thrombus (LVT) is not uncommon and pose a risk of systemic embolism, which can be mitigated by adequate anticoagulation. Direct oral anticoagulants (DOACs) are increasingly being used as alternatives to warfarin for anticoagulation, but their efficacy and safety profile has been debated. We aim to compare the therapeutic efficacy and safety of DOACs versus warfarin for the treatment of LVT. Methodology We systematically searched PubMed/Medline, Google Scholar, Cochrane library, and LILCAS databases from inception to 14th August 2020 to identify relevant studies comparing warfarin and DOACs for LVT treatment and used the pooled data extracted from retrieved studies to perform a meta-analysis. Results We report pooled data on 1955 patients from 8 studies, with a mean age of 61 years and 59.7 years in warfarin and DOACs group, respectively. The pooled odds ratio for thrombus resolution was 1.11 (95% CI 0.51–2.39) on comparing warfarin to DOAC, but it did not reach a statistical significance (p = 0.76). The pooled risk ratio (RR) of stroke or systemic embolization and bleeding in patients treated with warfarin vs DOACs was 1.04 (95% CI 0.64–1.68; p = 0.85), and 1.15 (95% CI 0.62–2.13; p = 0.57), respectively; with an overall RR of 1.09 (95% CI 0.70–1.70; p = 0.48) for mortality. Conclusions DOACs appears to be non-inferior or at least as effective as warfarin in the treatment of left ventricular thrombus without any statistical difference in stroke or bleeding complications.

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Treatment of Left Ventricular Thrombus Using Warfarin Versus Direct Oral Anticoagulants Following Anterior Myocardial Infarction

Cited by 24 publications

References 0 publications

Direct Oral Anticoagulants in the Treatment of Left Ventricular Thrombus: A Retrospective, Multicenter Study and Meta-Analysis of Existing Data

Direct Oral Anticoagulants in the Treatment of Left Ventricular Thrombus: A Retrospective, Multicenter Study and Meta-Analysis of Existing Data

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

Warfarin versus direct oral anticoagulants for treating left ventricular thrombus: a systematic review and meta-analysis

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