• Zheng Xu, Xiaomin Li, Xuewen Li, Yuping Gao, and Xiaolong Mi.
• Department of Cardiovascular Medicine, Shanxi Bethune Hospital, Third Clinical Medical College of Shanxi Medical University, Taiyuan, China.
• Ann Palliat Med. 2021 Sep 1; 10 (9): 9427-9434.

BackgroundA retrospective cohort study was conducted to compare the efficacy and safety of direct oral anticoagulants (DOACs) and vitamin K antagonists (VKAs) in the treatment of patients with left ventricular thrombus (LVT).MethodsConsecutive patients admitted to our institution with LVT between February 2009 and December 2020 and treated with either DOACs or VKAs were considered for inclusion in this study. The outcomes included stroke or systemic embolism (SSE), thrombus resolution, and bleeding events.ResultsEighty-seven patients with LVT were identified. Of these, 25 patients were treated with DOACs and 62 patients were treated with VKA. The average follow-up period was 2.37±2.1 years. DOACs were associated with similar incidences of stroke (4.0% vs. 4.8%; P=0.158), systemic embolism (0% vs. 1.6%; P=0.906), SSE (4.0% vs. 6.5%; P=0.657), thrombus resolution (76.0% vs. 74.2%; P=0.057), and blooding events (4.0% vs. 3.2%; P=0.858) as compared to VKAs. In the univariate logistic regression analysis, there was a significant difference between the DOAC and VKA groups in the incidence of SSE when antiplatelets were controlled [odds ratio (OR) =0.34, 95% confidence interval (CI): 0.21, 0.98; P=0.027]. However, in the multivariate analysis, antiplatelets had no significant effect on the outcome (OR =0.41, 95% CI: 0.36, 1.54; P=0.366).ConclusionsDOACs had similar efficacy and safety to VKAs in the treatment of patients with LVT. Randomized controlled trials should be conducted to verify our findings.

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