Direct Oral Anticoagulants Versus Warfarin for the Treatment of Left Ventricular Thrombus: A Multicenter Retrospective Observational Study

Abstract

Vitamin K antagonists remain the mainstay of therapy in patients with left ventricular thrombus (LVT) because the efficacy of direct oral anticoagulants (DOACs) is not well-established. We performed a multicenter retrospective analysis of adults admitted between January 2015 and December 2021 and diagnosed with LVT to compare the safety and efficacy of warfarin versus DOACs. The primary outcome was thrombus resolution. Secondary outcomes included all-cause mortality, bleeding events, and stroke or systemic embolism. A total of 189 patients were included. The rate of thrombus resolution was similar in patients with LVT treated with DOACs compared with those treated with warfarin (DOACs 73.9%vs warfarin 68.5%, p = 0.489). In addition, all-cause mortality (DOACs 13.04% vs warfarin 9.79%, p = 0.583), bleeding events (DOACs 19.57% vs warfarin 13.99%, p = 0.361), and stroke or systemic embolism (DOACs 10.87% vs warfarin 15.38%, p = 0.446) were all similar in the 2 groups. In the propensity-matched group, 90 patients were included. Multivariate analysis showed no significant difference of using warfarin or DOACs on thrombus resolution (odds ratio [OR] 0.94, 95% confidence interval [CI] 0.858 to 1.029, p = 0.18), all-cause mortality (OR 1.032, 95% CI 0.906 to 1.176, p = 0.6354), bleeding events (OR 1.694, 95% CI 0.168 to 17.097, p = 0.655), or stroke or systemic embolism (OR 1.947, 95% CI 0.087 to 4.756, p = 0.6747). In conclusion, in our retrospective analysis, DOACs had similar efficacy and safety compared with warfarin in the treatment of LVT.