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The efficacy and safety of direct oral anticoagulants compared to warfarin for LV thrombus resolution
Session:
SESSÃO DE POSTERS 27 - FORMAÇÃO EM CARDIOLOGIA E FARMACOTERAPIA
Speaker:
Samuel Azevedo
Congress:
CPC 2025
Topic:
L. Cardiovascular Pharmacology
Theme:
31. Pharmacology and Pharmacotherapy
Subtheme:
31.1 Cardiovascular Pharmacotherapy
Session Type:
Cartazes
FP Number:
---
Authors:
Samuel Azevedo; Mariana Sousa Paiva; Carla Reis; Pedro Lopes; Sara Guerreiro; Pedro Freitas; João Abecasis; Marisa Trabulo; Antonio Ferreira; Regina Ribeiras; Jorge Ferreira; Francisco Gama
Abstract
<p style="text-align:justify"><span style="font-size:12px"><span style="font-family:Arial,Helvetica,sans-serif"><span style="color:#000000"><strong>Background and aim: </strong>Left ventricular thrombus (LVT) is a frequent complication of myocardial infarction (MI) and heart failure with reduced ejection fraction (HFrEF). Once diagnosed, anticoagulation with vitamin K antagonists (VKA) up to 6-months is recommended. Clinical experience with direct oral anticoagulation (DOAC) in this setting is scarce and contradicting. Our aim is to describe the effectiveness and safety of DOAC for LVT resolution compared to<span style="color:black"> warfarin.</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12px"><span style="font-family:Arial,Helvetica,sans-serif"><span style="color:#000000"><strong>Methods: </strong>Single-centre retrospective cohort study of consecutive patients with recently diagnosed LVT, either after MI or HFrEF, conducted from January 2010 to May 2024. Primary endpoint was LVT resolution whereas safety endpoints were major bleedings and thromboembolic events, both evaluated at 24months. Diagnosis and subsequent assessments were performed with echocardiography and complemented with cardiac magnetic resonance and computed tomography when appropriate. Decisions regarding anticoagulant type, dose and duration and any simultaneous antiplatelet therapy were left to physician’s discretion. </span></span></span></p> <p style="text-align:justify"><span style="font-size:12px"><span style="font-family:Arial,Helvetica,sans-serif"><span style="color:#000000"><strong>Results:</strong><strong> </strong>In a cohort of 171 patients (82.5% male; mean age 59.8 ± 14.7 years), 99 received DOAC therapy, while the remaining received warfarin (Figure 1). Primary endpoint occurred in 111 patients (64.9%). At 24 months, LVT resolution occurred significantly more in patients treated with DOAC (66.7%, n=66) compared to those on warfarin (50%, n=36), with an hazard ratio (HR) of 2.0 (95% CI: 1.07–3.73; <em>p</em>=0.029). Thrombus tended for faster resolution on DOAC (185 days [IQR: 97–377] vs. 220 days [IQR: 128–378], <em>p</em>=0.214). DOAC remained a significant predictor of LVT resolution, independently of simultaneous antiplatelet use (HR: 3.0, 95% CI: 1.414-6.131; <em>p</em>=0.004). During a median nine months period (IQR 5–23) 5 (2.9%) major bleeding, 9 (5.3%) thromboembolic events, and 9 (5.3%) deaths were recorded, without significant differences between therapeutic arms.</span></span></span></p> <p style="text-align:justify"><span style="font-size:12px"><span style="font-family:Arial,Helvetica,sans-serif"><span style="color:#000000"><strong>Conclusion: </strong>In this cohort, DOAC use for LVT showed improved resolution with similar safety profile compared to warfarin. Further randomized clinical trials are needed to confirm these findings.</span></span></span></p>
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