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Off-label use of direct oral anticoagulants (DOACs) has outpaced evidence of efficacy, including for left ventricular thrombi (LVT). We hypothesized that utilization of DOACs for LVT may be approaching that of more established agents and that differences in efficacy may exist.
We reviewed all LVT identified by echocardiography at a single center between 10/2013 and 12/2016. Means were compared via Student's t test, categorical variables via chi-square, survival via log-rank.
We identified 98 patients with LVT, of which 40 (40.8%) were treated with warfarin, 35 (35.7%) were treated with a DOAC, 7 (7.1%) were treated with another anticoagulant and 16 (16.3%) received no anticoagulation. Among DOACs, 26 received apixaban, 7 rivaroxaban and 2 dabigatran. There was less ischemic cardiomyopathy in the DOAC group, compared with warfarin (54.3% vs 77.5%, p = 0.001), but no differences in age, gender, BMI, ethnicity, follow-up period, ejection fraction, thrombus size or mobility, or history of atrial fibrillation or venous thromboembolism. At one year, there was no difference in survival free of stroke or systemic embolism (SSE) (88.0 % vs 77.9%, p = 0.719).
In a single-center study of patients with LVT, a substantial proportion were treated with a DOAC. Compared with warfarin, DOAC-treated patients had similar SSE-free survival. Although limited by retrospective nature and sample size, these findings suggest that DOACs may be a suitable treatment alternative for LVT.
Poster Hall, Hall A/B
Monday, March 12, 2018, 9:45 a.m.-10:30 a.m.
Session Title: Emerging Strategies, Ventricular Assist Devices and Transplantation
Abstract Category: 13. Heart Failure and Cardiomyopathies: Clinical
Presentation Number: 1279-105
- 2018 American College of Cardiology Foundation