Efficacy and Safety of Direct Oral Anticoagulants Versus Warfarin for the Treatment of Left Ventricular Thrombus Justin Joy, Darshan Patel, Adele Robbins Emory University Hospital - Atlanta, GA
Background/Purpose: There are currently no existing randomized controlled trials evaluating the efficacy and safety of anticoagulation in the treatment of left ventricular thrombus (LVT). Guideline recommendations on the most appropriate anticoagulation regimen and duration are primarily based on case reports, expert opinion, and epidemiologic data due the paucity of available data. The purpose of this retrospective chart review is to assess the efficacy and safety of the use of direct oral anticoagulants (DOACs) in comparison to warfarin for the treatment of LVT.
Methodology: A multi-center, retrospective chart review was conducted among patients with a diagnosis of LVT who were prescribed a DOAC or warfarin and through 7/1/2014 _x0013_ 7/1/2018. Patients were excluded if are obese (BMI>40), have had a prior stroke or an inherited hypercoagulable state (Protein C, S, or antithrombin III deficiency; factor V Leiden). All data was split into two groups depending on the type of anticoagulation treatment received: DOAC or warfarin. The primary endpoint was the resolution of thrombus within 6 months of initial diagnosis as determined by echocardiogram, cardiac magnetic resonance imaging, or computed tomography angiography (CTA). The secondary endpoints were the incidence of ischemic stroke or TIA, and incidence of major bleeding as defined by bleeding from critical site (intracranial, intraspinal, intraocular, retroperitoneal, gastrointestinal, and pericardial).
Results: Data collection is currently ongoing. From an initial list of 385 patients collected via ICD-9 and 10 codes, 111 patients were initially included based on a diagnosis of LVT. Of the remaining 111 patients, 74 of these received warfarin and 37 received a DOAC (22 apixaban, 14 rivaroxaban, 1 dabigatran).
Presentation Objective: Discuss the potential option of DOACs for the treatment of LVT
Self-Assessment: True or False: Current guideline recommendations regarding anticoagulation regimens are primarily based on randomized controlled trials.
