Treatment of Left Ventricular Thrombus with Direct Oral Anticoagulants: A Retrospective Observational Study

Abstract Background There is limited data on the efficacy of direct oral anticoagulants (DOACs) for the treatment of left ventricular thrombus. Currently, vitamin K antagonists (VKA) remain the preferred oral anticoagulant for left ventricular thrombus. In this retrospective study, we assessed the safety and efficacy of DOACs in comparison to VKA in patients with a new diagnosis of left ventricular thrombus. Methods We retrospectively identified all patients admitted to the 5 Catholic Health Initiative Omaha hospitals with a diagnosis of left ventricular thrombus between January 2012 and March 2019 and were discharged on oral anticoagulants. Patients were stratified into 2 groups: VKA or DOACs and followed for up to 1 year. We compared the outcomes of ischemic stroke, bleeding, and echocardiographic resolution of left ventricular thrombus between the 2 groups. Results A total of 99 patients were included in this study (mean age: 61 years, 29% females). Of these, 80 (81%) were discharged on VKA and 19 (19%) on DOACs. Stroke within one year of diagnosis occurred in 2 patients in the VKA group and none in the DOAC group (p=0.49). Bleeding events were observed in 5 patients (4 in the VKA group and 1 in the DOAC group; p=0.96). Ninety patients had follow-up echocardiogram; resolution of left ventricular thrombus was similar between the 2 groups (VKA vs DOAC: 81% vs 80%; p=0.9). Conclusion In patients with left ventricular thrombus, DOACs and VKA had similar rates of stroke and bleeding. These findings need confirmation in randomized clinical trials.