SPC365

Assessing the best Anticoagulation Strategy for Left Ventricle Thrombus after Anterior Myocardial Infarction

Session: SESSÃO DE POSTERS 27 - FORMAÇÃO EM CARDIOLOGIA E FARMACOTERAPIA
Speaker: Francisco Rodrigues Dos Santos

Congress: CPC 2025
Topic: L. Cardiovascular Pharmacology
Theme: 31. Pharmacology and Pharmacotherapy
Subtheme: 31.1 Cardiovascular Pharmacotherapy
Session Type: Cartazes
FP Number: ---
Authors: Francisco Rodrigues Dos Santos; Oliver Kungel; Gonçalo Ferreira; João Gouveia Fiúza; Mariana Duarte Almeida; Vanda Devesa Neto; António Costa; Inês Fiúza Pires

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Introduction</strong>: There is a lack of prospective randomized data on the optimal anticoagulation regimen for treatment of Left Ventricle Thrombus (LVT) following Acute Myocardial Infarction (AMI). The choice of therapy should be tailored to the patient&rsquo;s clinical status and the results of follow-up investigation. The aim of this study is to evaluate the impact of Vitamin K Antagonists (VKAs) comparing to Direct Oral Anticoagulants (DOAC) in patients with LVT after AMI.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods</strong>: Retrospective analysis of patients diagnosed to LVT after anterior STEMI between January 2019 and December 2023. All patients underwent treatment with Percutaneous Coronary Intervention (PCI). LVT diagnosis was made by transthoracic echocardiography (TTE) in the first 2 weeks after AMI.&nbsp; Anticoagulation strategy was adopted by the clinician, considering patient&rsquo;s clinical status. Patients were divided into two groups (DOAC vs VKA) and the following outcomes were considered in the follow-up period: major haemorrhagic events, stroke, all-cause mortality and LVT resolution in following TTE, 3-6 months after LVT diagnosis<span style="color:black">. </span><span style="background-color:white"><span style="color:black">Chi-square and Mann-Whitney U tests were used for group comparisons and Cox regression analysis was used for multivariable analysis</span></span><span style="font-size:14.0pt"><span style="background-color:white"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#212529">.</span></span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:black"><strong><span style="font-size:11.0pt">Results</span></strong><span style="font-size:11.0pt"><span style="color:black">: <span style="background-color:white">The study sample included 90 patients, with a mean age of 65,9 </span></span></span><span style="font-size:11.0pt"><span style="color:#1c1e21">&plusmn;12,2, </span></span><span style="font-size:11.0pt"><span style="background-color:white"><span style="color:black">81.1% (n=73) male, with a mean LVEF of 37.6%. 62.2% (n=56) of patients were on DOAC therapy. Over a mean follow-up period of 2.4 years, the following outcomes were observed: stroke in 12,2% (n=11) patients, hospitalizations in 55.6% (n=50) patients, haemorrhagic events in 14.4% (n=13) patients, thrombus resolution in 51,0% (n=46) patients and mortality in 15.6% (n=14) patients. Patients on DOACs showed a reduced risk of stroke (</span></span></span><span style="font-size:11.0pt"><span style="color:black">5.4% vs 23.5%; &chi;&sup2; = 6.512</span></span><span style="font-size:11.0pt"><span style="background-color:white"><span style="color:black">, p=0.018), a reduced risk of haemorrhagic events (</span></span></span><span style="font-size:11.0pt"><span style="color:black">5.4% vs 29.4%; &chi;&sup2; = 9.905</span></span><span style="font-size:11.0pt"><span style="background-color:white"><span style="color:black">, p=0.004) and an increased rate of thrombus resolution on 3 to 6-month follow-up TTE (</span></span></span><span style="font-size:11.0pt"><span style="color:black">60,7% vs 35.3%; &chi;&sup2; = 7.421 p=0.024</span></span><span style="font-size:11.0pt"><span style="background-color:white"><span style="color:black">). No statistically significant impact was observed on mortality (p=0.136) or hospitalizations (p=0.258). </span></span></span><span style="font-size:11.0pt">Multivariate logistic regression analysis supported previous results showing a reduced risk of stroke (OR: 0.184, 95% CI: 0.045&ndash;0.752, p=0.018), haemorrhagic events (OR: 0.136, 95% CI: 0.034&ndash;0.539, p=0.005) and an increased rate of thrombus resolution on TTE (OR: 3.643, 95% CI: 1.395&ndash;9.511, p=0.008) in the DOAC group.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="background-color:white"><span style="color:black">Conclusion</span></span></strong><span style="background-color:white"><span style="color:black">: This analysis suggests that DOAC are viable option for LVT treatment, with best safety profile. These findings support recent evidence favouring DOACs over VKAs. However, despite their potential relevance to daily clinical practice, these results should be validated in randomized controlled trials.</span></span></span></span></p>