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Anticoagulation in Intraventricular Thrombus: Contemporary Trends and Comparative Effectiveness of Warfarin versus Direct Oral Anticoagulants
Session:
Sessão de Posters 22 - Imagem em hemodinâmica complexa e doença valvular
Speaker:
Joana Gonçalves
Congress:
CPC 2026
Topic:
B. Imaging
Theme:
03. Imaging
Subtheme:
03.1 Echocardiography
Session Type:
Posters Eletrónicos
FP Number:
---
Authors:
Joana Conde Gonçalves; Luana Alves; Emanuel Oliveira; Bernardo Cruz; Benedita Viana; Erivaldo Figueiredo; Tiago Branco; Mariana Paiva; Rui Rodrigues
Abstract
<p><strong><span style="font-size:12.0pt"><span style="font-family:"Calibri",sans-serif">Introduction:</span></span></strong></p> <p><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="font-family:"Calibri",sans-serif">Intraventricular thrombus (IVT) is a clinically significant finding, associated with increased risk of systemic embolization and adverse cardiovascular outcomes. Although vitamin K antagonists—particularly warfarin—have long constituted the mainstay of therapy, the use of direct oral anticoagulants (DOACs) has expanded in recent years. This study sought to assess temporal trends in anticoagulation strategies and to compare the effectiveness of warfarin and DOACs in achieving thrombus resolution.</span></span></span></p> <p><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="font-family:"Calibri",sans-serif">Methods:</span></strong><br /> <span style="font-family:"Calibri",sans-serif">We conducted a retrospective analysis of patients with echocardiographically confirmed IVT between January 2022 and December 2023. Clinical data, echocardiographic findings and anticoagulation strategies were retrieved from patient records. Prescription patterns were analyzed over time, and comparative effectiveness between anticoagulant classes was assessed using Kaplan–Meier survival analysis truncated at 24 months, with complete thrombus resolution as the event of interest.</span></span></span></p> <p><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="font-family:"Calibri",sans-serif">Results:</span></strong><br /> <span style="font-family:"Calibri",sans-serif">A total of 102 patients were included (median age 65 years; 84% male). A pronounced temporal shift in anticoagulation strategy was observed: warfarin prescription declined from 88.9% in 2022 to 52.9% in 2023 (p<0.001), reflecting a substancial rise in DOAC prescriptions. Follow-up echocardiography was available for 80 patients; others were censored due to death or loss to follow-up. In survival analysis, both warfarin and DOACs demonstrated comparable cumulative probabilities of complete thrombus resolution over 24 months (log-rank p=0.94).</span></span></span></p> <p><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="font-family:"Calibri",sans-serif">Conclusion:</span></strong><br /> <span style="font-family:"Calibri",sans-serif">This real-world cohort illustrates an ongoing paradigm shift in the management of IVT, characterized by a transition from warfarin to DOAC therapy. Both classes achieved similar long-term rates of thrombus resolution, suggesting equivalent effectiveness in clinical practice. These findings reinforce the role of DOACs as a feasible and effective therapeutic alternative to warfarin. Prospective randomized trials are needed to confirm their comparative efficacy and optimize anticoagulation strategies in this high-risk population.</span></span></span></p>
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