Abstract Details

Title Direct Oral Anticoagulants Versus Vitamin K Antagonists for Left Ventricular Thrombi Management

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P3 - Poster Session 3 (5:30 PM-6:30 PM)

Poster/Presentation
Number 5-008

Background Left ventricular thrombi (LVT) is a source of stroke in patients with ischemic and non-ischemic cardiomyopathies. Although historically managed by vitamin K antagonists (VKAs), the significant drawbacks of VKAs have led to the off-label usage of direct oral anticoagulants (DOACs). Currently, there is no consensus regarding the efficacy and safety profile of DOACs compared to VKAs or the resulting neurological outcomes.

Objective

To compare the rates of ischemic stroke, major bleeding, transient ischemic attack (TIA), and intracranial hemorrhage (ICH) through a matched analysis of patients receiving DOACs or VKAs for left ventricular thrombus management.

Design/Methods In this retrospective all-payer database analysis, 3,152 patients who received DOACs or VKAs for LVT were identified. Chi-squared tests were used to assess differences in outcomes: occurrence of ischemic stroke, major bleed, TIA, and ICH between the two groups. Differences in overall survival were calculated using the Kaplan-Meier method. Data was analyzed using R (Version 4.1, R Foundation, Vienna, Austria).

Results Following the matching process, 168 patients in each cohort were compared. Patients were mainly aged between 50-75, were male (80.1%), and had histories of hypertension (77.38%) and hyperlipidemia (66.07%). At the 24-month follow-up, there were no differences in the rates of ischemic stroke (143/168 vs. 142/168, p = 1), major bleed (132/168 vs. 124/168, p = 0.37), TIA (158/168 vs 164/168, p = 0.17), and ICH (164/168 vs 164/168, p = 1) between groups.

Conclusions

This study contributes to the sparse literature on DOAC vs VKA use in LVT management. DOACs appear to be non-inferior to VKAs with regard to safety. Accordingly, extensive prospective studies for further evaluation are warranted.

Authors/Disclosures
Pranav Mirpuri PRESENTER	Mr. Mirpuri has nothing to disclose.
Syed Khalid	No disclosure on file