Abstract 11251: Warfarin versus Direct Oral Anticoagulants for the Treatment of Left Ventricular Thrombus; A Multicenter Retrospective Observational Study

Abstract

Introduction: Left Ventricular (LV) thrombus formation is seen in some patients with severely reduced ejection fraction. Current guidelines recommend the use of warfarin in patients with LV thrombus. However, safe and effective warfarin use is often inconvenient and burdensome to some patients. Hypothesis: Direct oral anticoagulants (DOACs) are as effective as warfarin in the treatment of LV thrombus. Methods: We performed a multicenter retrospective analysis of adults admitted between January 2015 and December 2021 and diagnosed with LV thrombus. The primary outcome was thrombus resolution. Secondary outcomes included all-cause mortality, bleeding events and stroke or systemic embolism (SSE). Chi-square test was used to compare categorical variables. T-test was used for continuous variables comparison. Logistic regression was used to evaluate primary and secondary outcomes to control confounding factors such as demographic and comorbidity information. Results: A total of 194 patients were included, 48 (24.7%) of whom were treated with DOACs. The mean age was 61.6 ±13.3 years and 46 (23.7%) of the population were females. The two arms had no significant differences in age, sex, BMI, CHA2DS2-VASc score, history of DM, HTN, atrial fibrillation or ischemic cardiomyopathy. The rate of thrombus resolution (DOACs 58.3% vs warfarin 66.4%, p=0.309) and bleeding events (DOACs 14.6% vs warfarin 13.7%, p=0.878) were similar in both arms. The rate of SSE was numerically lower in the DOACs arm without statistical significance (DOACs 8.3% vs warfarin 15.07%, p=0.309). All-cause mortality was significantly higher in the DOACs arm (DOACs 22.9% vs warfarin 10.3%, p=0.026). In multivariate analysis, there was no significant effect of using warfarin on thrombus resolution, all-cause mortality, bleeding evens, and SSE (Figure). Conclusions: In our retrospective analysis, DOACs had similar efficacy and safety when compared to warfarin in the treatment of LV thrombus.