Background: Thromboembolic events are serious left ventricular thrombus (LVT) complications. Despite the limitations of vitamin K antagonist (VKA) drugs, it continues to be the recommended oral anticoagulation for LVT. Recently, nonvitamin K oral antagonist (NOAC) has gained popularity as an off-labeled treatment for systemic embolism prevention in LVT.
Objective: In this study, we aim to compare the outcomes (stroke and bleeding) of warfarin versus NOAC therapy in patients with LVT.
Methods: This retrospective cohort study compares NOAC and VKA therapy in LVT patients. We enrolled 201 patients with an echocardiography-confirmed LVT from January 2018 to December 2022. Patients who received NOAC therapy (NOAC, = 77) were compared to VKA patients (VKA, = 124). The primary endpoint was a composite of stroke, minor and major bleeding.
Results: The median follow-up time was 17 months (25-75 percentiles: 8-38). On unmatched analysis, both groups had no difference in major bleeding (log-rank, = 0.61) and stroke (log-rank, = 0.77). However, all bleeding events were higher with NOAC (log-rank, = 0.01). On matched analysis, there was no difference between both groups in the overall bleeding events ( = 0.08), major bleeding ( = 0.57), and stroke ( = 0.66). Minor bleeding was significantly lower in the VKA group ( = 0.04).
Conclusion: In patients with LVT, NOAC was as effective as VKA in stroke prevention without increasing the risk of major bleeding.
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| http://dx.doi.org/10.4103/jfmpc.jfmpc_1905_23 | DOI Listing |
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