Abstract 11121: Outcomes in Left Ventricular Thrombi Treated with Direct Oral Anticoagulants at a Safety Net Hospital

Abstract

Introduction: Direct oral anticoagulants (DoACs) are increasingly used off-label for the treatment of left ventricular (LV) thrombus due to ease of use. Current efficacy and safety data are mixed. DoACs offer advantages in low resource populations and have not been studied in this context. This study aimed to assess the efficacy of DOACs for the treatment of LV thrombus in a medically underserved population. Methods: A retrospective chart review was performed of patients treated with DoACs for LV thrombus from January 2017 to February 2020 in a medically underserved, multi-ethnic population receiving care at a large county hospital. Baseline demographic, clinical, and echocardiographic data were collected. Adverse events were obtained via chart review. AE were categorized into fatal bleeding, intracerebral hemorrhage and non-hemorrhagic stroke documented on CT or MRI, bleeding event requiring transfusion, myocardial infarction, and death. Results: Forty patients were identified. Average age was 52 ± 11 years, 19 (48%) were African American and 12 (30%) were women. At thrombus diagnosis, 19 (48%) initiated rivaroxaban. 21 started warfarin then transitioned to rivaroxaban (17, 43%) or apixaban (4, 10%). Average LV ejection fraction at diagnosis was 23 ± 13 % and average treatment length was 16 ± 10 months. Twenty-two (76%) of 29 follow up echoes showed thrombus resolution. Four patients were lost to follow up. Adverse events included 2 non-hemorrhagic strokes and 3 deaths. Conclusion: This is the largest single center retrospective study of LV thrombi at a publicly funded, county hospital caring for a diverse, medically underserved patient population. For this patient population treated with DoACs, successful resolution of LV thrombi occurred in most patients with few adverse events. These results underscore the need for randomized trials to understand the efficacy and safety of DOACs for the treatment of LV thrombus, particularly in underserved communities.