scholarly journals Non-vitamin K oral anticoagulants versus warfarin for treating left ventricular thrombus

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
K.K.H Kam ◽  
J.S.K Chan ◽  
A.P.W Lee
Keyword(s):  
Vitamin K ◽  
Oral Anticoagulants ◽  
Left Ventricular ◽  
Left Ventricular Thrombus ◽  
Safe Alternative ◽  
Cumulative Mortality ◽  
Ventricular Thrombus ◽  
Secondary Outcomes ◽  
One Year

Abstract Background Left ventricular thrombus (LVT) is associated with significant morbidity and mortality. Traditionally treated with anticoagulation by Warfarin, it is unclear if non-vitamin K oral anticoagulants (NOAC) are comparably efficacious and safe. Such data is also scarce in Asian patients. Purpose To compare the clinical efficacy and safety of NOAC with warfarin for managing LVT. Methods Clinical and echocardiographic records of all adult patients with echocardiography-confirmed LVT during January 2011 to January 2020 were retrieved. Any discontinuation of anticoagulation at one year was recorded. Outcomes of patients on NOAC were compared to those on warfarin. The primary outcomes were cumulative mortality and net adverse clinical events (NACE; any of cerebrovascular accident, systemic thromboembolism, intracranial haemorrhage, fatal bleeding, and overt bleeding). Secondary outcomes were complete LVT resolution and percentage reduction in LVT size at three-month follow-up, and the components of NACE. Results In total, 43 patients were included; 28 were treated by warfarin and 15 by NOAC, with mean follow-up periods of 20±12 months and 22±9 months respectively (p=0.522). Significantly fewer NACE were observed in the NOAC cohort (p=0.046; Figure 1), with a trend for lower cumulative mortality (p=0.058; Figure 2). There were no significant differences in the secondary outcomes. Additionally, given resolution of LVT, discontinuation of anticoagulation by one year was not associated with significantly different outcomes. Conclusion NOAC may be an efficacious and safe alternative to warfarin for treating LVT. Further studies are required to confirm our findings and delineate the optimal duration of anticoagulation. FUNDunding Acknowledgement Type of funding sources: Other. Main funding source(s): Hong Kong Special Administrative Region Government Health and Medical Research Fund Figure 1 Figure 2

scholarly journals The use of novel oral anticoagulants compared to vitamin K antagonists (warfarin) in patients with left ventricular thrombus after acute myocardial infarction

2020 ◽  
Author(s):  
Daniel A Jones ◽  
Paul Wright ◽  
Momin A Alizadeh ◽  
Sadeer Fhadil ◽  
Krishnaraj S Rathod ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Vitamin K ◽  
Oral Anticoagulants ◽  
Left Ventricular ◽  
Left Ventricular Thrombus ◽  
Novel Oral Anticoagulants ◽  
Secondary Outcome ◽  
Ventricular Thrombus

Abstract Aim Current guidelines recommend the use of vitamin K antagonist (VKA) for up to 3–6 months for treatment of left ventricular (LV) thrombus post-acute myocardial infarction (AMI). However, based on evidence supporting non-inferiority of novel oral anticoagulants (NOAC) compared to VKA for other indications such as deep vein thrombosis, pulmonary embolism (PE), and thromboembolic prevention in atrial fibrillation, NOACs are being increasingly used off licence for the treatment of LV thrombus post-AMI. In this study, we investigated the safety and effect of NOACs compared to VKA on LV thrombus resolution in patients presenting with AMI. Methods and results This was an observational study of 2328 consecutive patients undergoing coronary angiography ± percutaneous coronary intervention (PCI) for AMI between May 2015 and December 2018, at a UK cardiac centre. Patients’ details were collected from the hospital electronic database. The primary endpoint was rate of LV thrombus resolution with bleeding rates a secondary outcome. Left ventricular thrombus was diagnosed in 101 (4.3%) patients. Sixty patients (59.4%) were started on VKA and 41 patients (40.6%) on NOAC therapy (rivaroxaban: 58.5%, apixaban: 36.5%, and edoxaban: 5.0%). Both groups were well matched in terms of baseline characteristics including age, previous cardiac history (previous myocardial infarction, PCI, coronary artery bypass grafting), and cardiovascular risk factors (hypertension, diabetes, hypercholesterolaemia). Over the follow-up period (median 2.2 years), overall rates of LV thrombus resolution were 86.1%. There was greater and earlier LV thrombus resolution in the NOAC group compared to patients treated with warfarin (82% vs. 64.4%, P = 0.0018, at 1 year), which persisted after adjusting for baseline variables (odds ratio 1.8, 95% confidence interval 1.2–2.9). Major bleeding events during the follow-up period were lower in the NOAC group, compared with VKA group (0% vs. 6.7%, P = 0.030) with no difference in rates of systemic thromboembolism (5% vs. 2.4%, P = 0.388). Conclusion These data suggest improved thrombus resolution in post-acute coronary syndrome (ACS) LV thrombosis in patients treated with NOACs compared to VKAs. This improvement in thrombus resolution was accompanied with a better safety profile for NOAC patients vs. VKA-treated patients. Thus, provides data to support a randomized trial to answer this question.

scholarly journals Rivaroxaban versus Vitamin K Antagonists (Warfarin) based on the triple therapy for left ventricular thrombus after ST-Elevation Myocardial Infarction

2021 ◽  
Author(s):  
Zhongfan Zhang ◽  
Qian Zhang ◽  
Ming Qu ◽  
Miao Yu ◽  
Zhenya Jiang ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Triple Therapy ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Left Ventricular ◽  
Left Ventricular Thrombus ◽  
St Elevation Myocardial Infarction ◽  
Ventricular Thrombus ◽  
St Elevation

Abstract Background: Left ventricular thrombus(LVT) can lead to serious complications, and mostly formed after ST-Elevation myocardial infarction(STEMI). The Off-label use of new oral anticoagulants(NOACs) in the triple therapy of LVT after STEMI has increased in the past few years. As one of the most widely used NOACs, the data of safety and efficacy of rivaroxaban in LVT after STEMI is limited and warrants continued exploring.Methods: We conducted a retrospective cohort study involving STEMI patients underwent primary percutaneous coronary intervention (PCI). Among patients who developed LVT after STEMI, we evaluated the efficacy and safety of rivaroxaban plus DAPT therapy associated with thrombus resolution and clinical adverse events, compared with triple therapy with VKA. Results: In 1,335 patients with STEMI, a total of 77 (5.7%) developed LVT over the follow up period (median 25.0 months). Of the patients diagnosed with LVT, 31 patients were started on triple therapy with VKA, 33 patients on triple therapy with rivaroxaban. There was a consistent similarity in LVT resolution with rivaroxaban application compared to VKA application during the follow-up period[HR:1.57(95%CI 0.89-2.77), p=0.096; Adjusted HR:1.70(95%CI 0.90-3.22), p=0.104]. When the analysis focused on LVT resolution at different time points during the follow-up period, triple therapy with rivaroxaban showed quicker resolution than with VKA(6months:p=0.049; 12months:p=0.044; 18months:p=0.045). Meanwhile, similar risks of ISTH bleeding were recorded in both groups, with no difference between the two groups(Rivaroxaban 6.1% vs VKA 9.7% , p=0.444). Fewer net adverse clinical events(NACE) were observed in the rivaroxaban group compared with the VKA group[Rivaroxaban 24.2% vs VKA 58.1%; HR:0.31(95%CI 0.14-0.68), p=0.003; Adjusted HR: 0.23(95%CI 0.09-0.57), p=0.001].Conclusions: This observational study suggests triple therapy with rivaroxaban has similar and quicker LVT resolution in patients with LVT after STEMI, compared with triple therapy with VKA, and perhaps was accompanied with a better clinical benefit. Larger sample sizes and randomized controlled trials are needed to confirm this observation.

Efficacy and Safety of Direct Oral Anticoagulants Versus Vitamin K Antagonists in the Treatment of Left Ventricular Thrombus

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Cameron Burmeister ◽  
Azizullah Beran ◽  
Mohammed Mhanna ◽  
Sami Ghazaleh ◽  
Jeremy C. Tomcho ◽  
...  
Keyword(s):  
Vitamin K ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Left Ventricular ◽  
Left Ventricular Thrombus ◽  
Efficacy And Safety ◽  
Ventricular Thrombus
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