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Comparative effectiveness of direct oral anticoagulants and warfarin for the treatment of left ventricular thrombus

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Abstract

Left ventricular (LV) thrombus is a complication of acute endomyocardial injury and chronic ventricular wall hypokinesis, resulting in increased risk of thromboembolic complications. Observational studies support the general safety and efficacy of warfarin for this indication. Limited data exists regarding the use of direct oral anticoagulants (DOACs) for LV thrombus. This retrospective cohort study sought to compare the incidence of thromboembolic events, bleeding rates, and blood product administration in patients receiving a DOAC versus warfarin. A total of 949 patients met inclusion, 180 (19%) received a DOAC and 769 (81%) warfarin. For the primary endpoint of new onset thromboembolic stroke, no difference existed between treatments (DOAC: 7.8% vs warfarin: 11.7%, p = 0.13). When compared to warfarin, no difference existed in the composite of thromboembolic events (33% vs 30.6%, p = 0.53, respectively) or in GUSTO bleeding (10.9% vs 7.8%, p = 0.40, respectively). More patients on warfarin received blood products compared to those taking a DOAC (25.8% vs 13.9%, p < 0.001).

DOACs may be an alternative to warfarin for the treatment of LV thrombus based on a retrospective assessment of thromboembolic events and GUSTO bleeding events within 90 days of diagnosis of LV thrombus. However, further prospective studies are warranted.

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Acknowledgements

Supported by the Health Data Compass Data Warehouse project (healthdatacompass.org).

Funding

This study was supported by the Colorado Clinical and Translational Sciences Institute (CCTSI). The CCTSI is supported in part by Colorado CTSA Grant UL1TR001082 from NCATS/NIH.

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Authors and Affiliations

  1. Department of Pharmacy, UCHealth - University of Colorado Hospital, 12505 E. 16th Avenue, Aurora, CO, 80045, USA

    Megan E. Bass & Courtney Shakowski

  2. Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA

    Tyree H. Kiser, Robert L. Page II & Garth Wright

  3. Department of Medicine, Division of Cardiology, University of Colorado School of Medicine, Aurora, CO, USA

    Colleen K. McIlvennan & Larry A. Allen

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  1. Megan E. Bass
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  2. Tyree H. Kiser
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Correspondence to Courtney Shakowski.

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Conflict of interest

Dr. Allen reports research funding from PCORI, AHA, NIH. Consulting fees from ACI Clinical, Amgen/Cytokinetics, Boston Scientific. All other authors having nothing to disclose.

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Bass, M.E., Kiser, T.H., Page, R.L. et al. Comparative effectiveness of direct oral anticoagulants and warfarin for the treatment of left ventricular thrombus. J Thromb Thrombolysis 52, 517–522 (2021). https://doi.org/10.1007/s11239-020-02371-6

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  • DOI: https://doi.org/10.1007/s11239-020-02371-6

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