Abstract 11359: Safety and Efficacy of DOACs Compared to Vitamin K Antagonist in the Treatment of Left Ventricular Thormbus

Abstract

Introduction: The Safety and efficacy of DOACs is unknown in patients with left ventricular thrombus as these patients were excluded from DOAC trials. Hypothesis: The safety and efficacy of DOACs is comparable to vitamin K antagonists Methods: Databases including Medline, Scopus and Cochrane Central Registration of Controlled Trials were queried from inception to March 30 th 2022. Studies reporting efficacy and safety outcomes were selected for the analysis. Results: We included 11 studies comprising 1920 patients with left ventricular thrombus. The mean age in the DOAC group was 57.5 years (SD 12.8) and 58.6 years (SD 13.0) in the VKA group; 26.8% were females. Pooled results showed no difference in mortality (RR, 0.64 [95% CI, 0.16-2.52]) embolic events (RR, 0.94 [95% CI, 0.59-1.50]) or major bleeding (RR, 0.95[95% CI, 0.66-1.36]) in the DOACs compared to VKA groups. Event rate for DOAC group compared to VKA group was 12.7 vs 17.5 per 100 patient-years (mean follow up of 4.0 months) for mortality, 19.5 vs 26.5 per 100 patient-years (mean follow up of 8.9 months) for embolic events and 8.0 vs 10.0 per 100 patient-years (mean follow up of 9.5 months) for major bleeding. Conclusions: These data, from observational and randomized studies, demonstrate promising safety and efficacy of DOACs for treatment of left ventricular thrombus. Elevated embolic and mortality rates regardless of anticoagulant choice emphasize the need for further research to improve outcomes for patients with this complication.