What is the comparative effectiveness of DOACs versus VKA in the treatment of LV thrombus?
A pooled meta-analysis of studies of mural thrombus after anterior MI showed that use of oral anticoagulation with VKA reduced the risk of stroke by 86% and resulted in resolution of LV thrombus in 68%. A single-center retrospective study of anticoagulation with a DOAC in 52 patients for the treatment of LV thrombus found resolution of the thrombus in 86% of patients on follow-up echocardiography, but the study was too small to address embolic event rates. A larger retrospective analysis of 514 patients with identified LV thrombi from 3 centers and a median follow-up of 351 days compared 300 patients who received warfarin with 185 patients treated with DOAC and noted a higher rate of stroke or systemic embolism in the DOAC group (HR, 2.71 versus warfarin), although this difference was noted beyond the currently recommended duration of therapy for LV thrombi.513