Direct Oral Anticoagulants Versus Vitamin K Antagonists for Left Ventricular Thrombi Management
Pranav Mirpuri1, Syed Khalid2
1Rosalind Franklin University of Medicine and Science, Chicago Medical School, 2Department of Neurosurgery, University of Illinois Chicago
Objective:
To compare the rates of ischemic stroke, major bleeding, transient ischemic attack (TIA), and intracranial hemorrhage (ICH) through a matched analysis of patients receiving DOACs or VKAs for left ventricular thrombus management.
Background:
Left ventricular thrombi (LVT) is a source of stroke in patients with ischemic and non-ischemic cardiomyopathies. Although historically managed by vitamin K antagonists (VKAs), the significant drawbacks of VKAs have led to the off-label usage of direct oral anticoagulants (DOACs). Currently, there is no consensus regarding the efficacy and safety profile of DOACs compared to VKAs or the resulting neurological outcomes.
Design/Methods:
In this retrospective all-payer database analysis, 3,152 patients who received DOACs or VKAs for LVT were identified. Chi-squared tests were used to assess differences in outcomes: occurrence of ischemic stroke, major bleed, TIA, and ICH between the two groups. Differences in overall survival were calculated using the Kaplan-Meier method. Data was analyzed using R (Version 4.1, R Foundation, Vienna, Austria).
Results:
Following the matching process, 168 patients in each cohort were compared. Patients were mainly aged between 50-75, were male (80.1%), and had histories of hypertension (77.38%) and hyperlipidemia (66.07%). At the 24-month follow-up, there were no differences in the rates of ischemic stroke (143/168 vs. 142/168, p = 1), major bleed (132/168 vs. 124/168, p = 0.37), TIA (158/168 vs 164/168, p = 0.17), and ICH (164/168 vs 164/168, p = 1) between groups.
Conclusions:
This study contributes to the sparse literature on DOAC vs VKA use in LVT management. DOACs appear to be non-inferior to VKAs with regard to safety. Accordingly, extensive prospective studies for further evaluation are warranted.