Characteristics of Novel Anticoagulants versus Vitamin K Antagonists in the Ventricular Mural Thrombus

Abstract

Background: To describe the characteristics, treatment practices, and clinical outcomes of patients with ventricular mural thrombus (VMT), with emphasis on the comparison of non-vitamin K antagonist oral anticoagulants (NOACs) and vitamin K antagonists (VKAs). Methods: We performed a retrospective cohort study between 2010 and 2019 in Fuwai Hospital, China. Patients with VMT newly treated with either NOACs or VKAs were included. The primary outcome was the incidence rate of thrombus resolution at 3 months. Results: We included 196 patients in total-68.9% (n = 135) were treated with VKAs while 31.1% (n = 61) were on NOACs. Patients with a medical history of heart failure (HF) (odds ratio (OR) 2.10, 95% confidence interval (CI) 1.17 to 3.77, p = 0.013) and a lower left ventricular ejection fraction (OR 0.36, 95% CI 0.20 to 0.65, p = 0.001) had a higher thrombus resolution. At 3 months, a significant difference was observed in the thrombus resolution between the NOACs and VKAs group with or without adjustment (OR 2.61, 95% CI 1.39 to 4.89, p = 0.003; adjusted OR 2.93, 95% CI 1.51 to 5.66, p = 0.001). Further investigation revealed that in the majority of the subgroups, individuals receiving NOAC therapy had a superior thrombus resolution than those receiving VKA therapy. Conclusions: Patients with a medical history of HF or left ventricular ejection fraction <30% experienced greater effectiveness in thrombus resolution. Additionally, the resolution of VMT with NOAC treatment was considerably higher than that with VKA therapy at 3 months, with or without adjusting for baseline variables. Clinical Trial Registration: This study was registered at ClinicalTrials.gov as NCT 05006677 on August 4th, 2021. Keywords: ventricular mural thrombus; anticoagulants; non-vitamin K antagonist oral anticoagulants; warfarinThis retrospective cohort study was conducted from July 2010 through October 2019 using electronic medical † Other diagnoses included hypertrophic cardiomyopathy, peripartum cardiomyopathy, myocarditis, arrhythmogenic right ventricular cardiomyopathy, hypertensive heart disease, and noncompaction of ventricular myocardium. § Excessive alcohol consumption: >40 grams per day for women and >80 grams per day for men, lasting more than 5 years.Abbreviations: VMT, ventricular mural thrombus; SD, standard deviation; IQR, interquartile range; NOACs, non-vitamin K antagonist oral anticoagulants; VKAs, vitamin K antagonists; BMI, body mass index; ICM, ischemic cardiomyopathy; DCM, dilated cardiomyopathy; LVEF, left ventricular ejection fraction.