Non-vitamin K oral anticoagulants versus warfarin for treating left ventricular thrombus

Abstract

Abstract Background Left ventricular thrombus (LVT) is associated with significant morbidity and mortality. Traditionally treated with anticoagulation by Warfarin, it is unclear if non-vitamin K oral anticoagulants (NOAC) are comparably efficacious and safe. Such data is also scarce in Asian patients. Purpose To compare the clinical efficacy and safety of NOAC with warfarin for managing LVT. Methods Clinical and echocardiographic records of all adult patients with echocardiography-confirmed LVT during January 2011 to January 2020 were retrieved. Any discontinuation of anticoagulation at one year was recorded. Outcomes of patients on NOAC were compared to those on warfarin. The primary outcomes were cumulative mortality and net adverse clinical events (NACE; any of cerebrovascular accident, systemic thromboembolism, intracranial haemorrhage, fatal bleeding, and overt bleeding). Secondary outcomes were complete LVT resolution and percentage reduction in LVT size at three-month follow-up, and the components of NACE. Results In total, 43 patients were included; 28 were treated by warfarin and 15 by NOAC, with mean follow-up periods of 20±12 months and 22±9 months respectively (p=0.522). Significantly fewer NACE were observed in the NOAC cohort (p=0.046; Figure 1), with a trend for lower cumulative mortality (p=0.058; Figure 2). There were no significant differences in the secondary outcomes. Additionally, given resolution of LVT, discontinuation of anticoagulation by one year was not associated with significantly different outcomes. Conclusion NOAC may be an efficacious and safe alternative to warfarin for treating LVT. Further studies are required to confirm our findings and delineate the optimal duration of anticoagulation. Funding Acknowledgement Type of funding sources: Other. Main funding source(s): Hong Kong Special Administrative Region Government Health and Medical Research Fund Figure 1Figure 2