Abstract 11808: Direct Oral Anticoagulant Use in Preventing Ischemic Stroke in Patients With Left Ventricular Thrombus

Abstract

Background: Left Ventricular thrombus are commonly associated with systolic heart failure and acute myocardial infarctions. It is thought to be associated with an increased risk of embolic events. Current guidelines recommend the use of Warfarin for these patients. Off label use of Direct Oral Anticoagulants (DOAC) for these patients are becoming increasingly frequent as Warfarin may be inappropriate for many of these patients. DOACs have already been shown to be advantageous to warfarin in the treatment of pulmonary embolisms, deep vein thrombosis, non-valvular atrial fibrillation and is even now being looked at some instances of valvular atrial fibrillation with updated mechanical valves. Methods: This is a retrospective study on patients diagnosed with a Left Ventricular thrombus discharged on a DOAC versus warfarin looking for ischemic stroke admissions, length of stay and comparing severities of stroke using NIHSS controlling for demographic, comorbid conditions, ED and ICU admissions. Data was collected from 144 HCA hospitals. Results: There were 1704 patients in the warfarin group and 2210 in the DOAC group. There was no statistically significant difference in the odds of being readmitted for ischemic stroke by DOAC compared to warfarin (OR=1.08, [95% CI (0.82, 1.44)], p=0.582). Patients discharged on DOAC had a 81% lower odds of being readmitted within 30 days compared to warfarin (OR=0.19, 95%CI [0.05, 0.76], p = 0.019). The patients with left ventricular thrombus discharged on warfarin showed a higher average length of stay (8.21 ± 9.73) compared to DOAC (6.35 ± 7.61) (p < .001). There was no statistically significant differences in the NIHSS scores by discharge medications (warfarin vs. DOACs, p=0.340). Conclusion: Our study showed no statistically significant difference in using DOAC’s compared to warfarin, the standard of care, in preventing a stroke in patients with a left ventricular thrombus. We were also able to show a decreased readmission rate, a decreased length of stay and no difference in the severity (NIHSS) of stroke. If this data holds true many patients and physicians will chose DOACs over warfarin to improve medication compliance, dosing burden and potential adverse drug interactions.