Abstract 17671: Comparative Analysis of Warfarin and Direct Oral Anticoagulants for the Treatment of Left Ventricular Thrombus

Abstract

Introduction: This study aims to evaluate the efficacy and safety of direct oral anticoagulants (DOACs) in the treatment of left ventricular thrombus (LVT). Warfarin has been shown to be an effective treatment in mitigating thrombotic events; however, numerous limitations exist, including the need for frequent monitoring and increased risk of side effects. Despite this, insight into DOAC use for the treatment of LVT remains limited. Thus, this study seeks to investigate the safety and efficacy of DOACs as a potential alternative to warfarin for the treatment of LVT. Hypothesis: DOACs decreases the risk of adverse events compared to Warfarin in patients with LVT. Methods: A retrospective cohort study was conducted using a federated realtime database called TriNetX which is comprised of over 100 million patient records. ICD-10 diagnostic codes and national drug codes were used to stratify adults by warfarin or DOAC treatment within 3 months of an initial LVT diagnosis. A 1:1 matched propensity score analysis was conducted, adjusting for comorbidities and demographics, to calculate adjusted Risk Ratios (aRR) with 95% CI. 90-day risk for mortality, stroke, need for blood transfusion, hemorrhage, and arterial embolism & thrombosis were examined. Results: In a matched sample of 11,206 patients in each cohort, patients with LVT who took warfarin within 3 months of initial diagnosis is at higher risk for stroke (aRR[95%CI]=1.44(1.34,1.55)], need for blood transfusion [1.29(1.11,1.51)], hemorrhage [1.56(1.35,1.8)], and arterial thromboembolism [1.28(1.13,1.45)] than LVT patients who took a DOAC. Risk for death was non-significant between cohorts. Conclusions: The findings from this large electronic medical record patient cohort establish higher rates of adverse events for patients with LVT treated with warfarin versus DOAC, with no statistically significant difference in therapeutic efficacy.