부산대학교 도서관

Introduction: Left ventricular thrombus (LVT) is associated with high risk of major adverse cardiovascular events (MACE) and mortality. Although warfarin is standard of care for LVT prevention and treatment, there is rising interest in the role of direct oral anticoagulants (DOACs). The goal of this study is to evaluate clinical outcomes of patients with LVT treated with DOACs compared to those treated with warfarin.Methods: Patients within a regional, multi-center health care system diagnosed with LVT from 2014-2018 were retrospectively identified through search of the electronic medical record. Demographic data, comorbidities, anticoagulation treatment, ejection fraction, and LVT etiology were recorded. Clinical outcomes including LV thrombus resolution, bleeding, and all-cause mortality were determined.Results: Demographic data is summarized in Table 1. Of 212 identified patients, 140 (66%) were treated with warfarin, 57 (26.9%) with DOAC, and 7 (3.3%) with low molecular weight heparin. Of these, 158 (74.5%) were on concomitant antiplatelet therapy. One patient was treated with antiplatelet therapy alone, and 7 patients received neither anticoagulation nor antiplatelet therapy. Patients treated with DOAC had no significant differences compared to those treated with VKA with respect to LVT resolution (69.3% vs 64.9, p = 0.95), hemorrhagic stroke (2.1% vs 1.8%, p = 0.86), ischemic stroke (2.1% vs 3.5%, p = 0.58), significant bleed (9.2% vs 12.3%, p = 0.78), and all-cause mortality (13.6% vs 15.8%, p = 0.17).Conclusions: In this large, multi-center retrospective study, clinical outcomes and adverse events of patients treated with DOAC for LVT are similar to VKA-treated patients. Given the observational nature of this study, randomized controlled studies are needed to validate these findings.