Background: Left ventricular thrombus (LVT) is a major complication of acute myocardial infarction (AMI). Until recently anticoagulation with a vitamin K antagonist has been the mainstay of treatment for LVT. DOACs provide a more acceptable form of anticoagulation however, outcome data on their use in LVT post AMI is limited.
Aims: To compare efficacy and safety of DOACs versus warfarin for patients diagnosed with LVT post AMI at King’s College Hospital, London.
Methods: Patients diagnosed with LVT post AMI between 1st January 2018 and 31st December 2020 were identified using the CogStack search tool. A retrospective case note review was conducted and each patient followed for 1 year after the index event. The primary endpoint was resolution of LV thrombus on repeat imaging, with secondary endpoints of bleeding (major bleed [MB] and clinically relevant non-major bleed [CRNMB]) or stroke or systemic embolism (SSE).
Results: Fifty-seven patients were diagnosed with an LVT post AMI (warfarin 72% and DOAC 28% – rivaroxaban, apixaban or edoxaban). Baseline characteristics were mostly well matched (Table 1). 89% of patients received concurrent dual antiplatelet therapy. The overall rate of thrombus resolution was 75% at first follow up imaging (table 1). Thrombus resolution in the warfarin group was 71% compared with 85% in the DOAC group (p=0.47). There were two SSE events, 1 in the warfarin and 1 in the DOAC group. There were 4 episodes of MB or CRNMB in the warfarin group, and none in the DOAC group (Table 2). There were two minor bleeding events, 1 in the warfarin group and 1 in the DOAC group. The overall difference in documented bleeding was not statistically significant (p=0.66).
Conclusion(s): Our data suggests that DOACs are as safe and effective as warfarin for the treatment of LVT associated with AMI and supports further widespread use for this indication.
To cite this abstract in AMA style:Byrne R, Czuprynska J, Speed V, Byrne J, Scott P, Clapham R, Patel R, Roberts L, Arya R, Patel J. Direct Oral Anticoagulants compared with Warfarin for the Treatment of Left Ventricular Thrombosis post Myocardial Infarction [abstract]. https://abstracts.isth.org/abstract/direct-oral-anticoagulants-compared-with-warfarin-for-the-treatment-of-left-ventricular-thrombosis-post-myocardial-infarction/. Accessed October 2, 2023.
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