Clinical Outcomes of DOACs Versus Warfarin for Ischemic Stroke Caused by Left Ventricular Thrombus
Jasmine Zhang1, Sophie Nguyen1, Faraz Behzadi1, Brigham Harrison1, Josephine Martin1, Judy Dawod2
1University of Arizona College of Medicine - Phoenix, 2Banner University Medical Center - Phoenix
Objective:
The objective of this study is to evaluate the relative clinical outcomes of warfarin and direct oral anticoagulant (DOAC) agents for patients who had ischemic stroke due to left ventricular thrombus (LVT).
Background:
LVT is a leading etiology of cardioembolic stroke, with early appropriate anticoagulation therapy essential. However, there is lack of robust evidence comparing warfarin against direct oral anticoagulants, and the choice of stroke prevention therapy in LVT patients remains based on the personal choice of the individual patient and physician.
Design/Methods:
This retrospective observational study included 48 adult patients treated for ischemic stroke secondary to LVT at our institution between 9/2017 and 12/2024. Patients were included if they were anticoagulated with warfarin or a DOAC and had follow-up cardiac imaging to assess thrombus resolution within 6 months of LVT diagnosis; and excluded if on anticoagulation prior to LVT diagnosis. We evaluated rates of LVT resolution and complications by anticoagulant usage.
Results:
By 6 months, 79% of patients achieved thrombus resolution. Five patients were switched from warfarin to a DOAC over the 6-month period. There was no statistically significant difference in thrombus resolution rates between warfarin, Apixaban, and Rivaroxaban use at initial diagnosis (p = 0.6). However, thrombus resolution was associated with DOAC use at 6 month follow-up (p = 0.07). Warfarin use trended towards a higher rate of complications, with 27.3% of patients experiencing complications compared to 3.8% among DOAC patients; however, overall number of complications was too small to reach statistical significance.
Conclusions:
These findings suggest that DOACs are non-inferior to warfarin for resolution of LVT by 6 months. Warfarin may be associated with greater complication risk within this time period and more difficulties for patient adherence. These factors should be taken into consideration when selecting an anticoagulant agent for patients diagnosed with LVT.
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