Efficacy and safety of direct oral anticoagulants for treatment of left ventricular thrombus; a systematic review

Kumar, Dilpat; Warsha, Fnu; Helmstetter, Nicholas; Gupta, Vishal

doi:10.1080/00015385.2021.1901024

Cited by 6 publications

(15 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In aspects of our key findings, patients diagnosed with VMT might benefit better from NOACs as a therapy option than of VKAs, which were in line with multiple additional studies [19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35] (Supplementary Table 4). Albabtain et al 2021 [22] found that in the warfarin group 68.6% of patients, and in the rivaroxaban group 71.4 % of patients, respectively, obtained thrombus resolution.…”

Section: Comparison Of Noacs Versus Vkas On Efficacy and Safety In Pa...supporting

confidence: 81%

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

Yang¹,

Yan²,

Quan³

et al. 2023

Rev. Cardiovasc. Med.

View full text Add to dashboard Cite

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.

show abstract

Section: Comparison Of Noacs Versus Vkas On Efficacy and Safety In Pa...supporting

confidence: 81%

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

Yang¹,

Yan²,

Quan³

et al. 2023

Rev. Cardiovasc. Med.

View full text Add to dashboard Cite

show abstract

“…[3][4][5][6][7][8][9][10][11] Risk factors for developing LV thrombus primarily include Virchow's triad: reduced ventricular contractility, local myocardial injury, and hypercoagulability. [2][3][4][5][6][7][8][9][10][11][12][13] Detection of LV Thrombus involves the use of transthoracic echocardiogram (TTE), transesophageal echocardiogram (TEE), computed tomography (CT), or cardiac magnetic resonance imaging (CMR). 2,4 In patients with a LV thrombus, there is concern for increased risk of systemic embolism, morbidity, and mortality.…”

Section: Introductionmentioning

confidence: 99%

“…2,4 In patients with a LV thrombus, there is concern for increased risk of systemic embolism, morbidity, and mortality. 2,[9][10][11][12][13][14] Following the diagnosis of LV thrombus, patients are typically anticoagulated for at least 3 months with warfarin to reduce further thromboembolic risk. 6 The 2012 American College of Chest Physician Evidence-Based Clinical Practice Guidelines only included warfarin in their recommendations for treatment following LV thrombus, with a goal INR of 2-3.…”

Section: Introductionmentioning

confidence: 99%

“…[17][18][19][20][21] While none of the DOACs (apixaban, rivaroxaban, dabigatran, or edoxaban) are currently approved by the United States Food and Drug Administration (FDA) for the treatment of LV thrombus, they have been used despite a paucity of large, randomized controlled trials. 1,2,13,14,[22][23][24][25][26][27][28] As numerous studies have evaluated DOACs in the treatment of LV thrombus, the AHA recently published a scientific statement addressing this practice. 29 This statement includes support of the use of DOACs as a reasonable alternative to warfarin in the treatment of LV thrombus.…”

Section: Introductionmentioning

confidence: 99%

“…29 Although current data supports the safety and efficacy of DOACs in LV thrombus treatment, there is limited data analyzing reduced dose DOACs for this indication. 1,2,13,14,[22][23][24][25][26][27][28][29] This report describes two patients successfully treated with apixaban at a reduced dose following LV thrombus diagnosis. The first case is an 83-year-old female admitted for acute MI and found to have LV thrombus treated with apixaban 2.5 mg BID.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Reduced-Dose Apixaban in the Treatment of Left Ventricular Thrombus: A Report of 2 Cases

Bundrick

Bowers

Perkins

et al. 2022

Journal of Pharmacy Practice

View full text Add to dashboard Cite

According to the American College of Cardiology and the American Heart Association, warfarin has historically been the standard of care anticoagulant for the treatment of left ventricular thrombus. The use of direct oral anticoagulants (DOACs) has become more prevalent, as they require less frequent laboratory monitoring, offer fixed-dose regimens, are associated with fewer drug-drug and drug-food interactions, and provide more favorable safety profiles when compared to warfarin. However, DOACs are not currently FDA-indicated in the treatment of left ventricular (LV) thrombus. Numerous recent studies have reported and evaluated the use of DOACs for treatment of LV thrombus. Recently, a prospective, open-label, multicenter study evaluated warfarin compared to DOACs for LV thrombus treatment. The AHA recently published a scientific statement regarding the management of patients at risk for and with left ventricular thrombus, which included DOACs as a reasonable alternative to warfarin. This report describes two patients treated with DOACs following LV thrombus diagnosis. The first case is a 71-year-old male admitted for cerebrovascular accident and non-ST-elevation myocardial infarction complicated by a LV thrombus. The second case is an 83-year-old female admitted for acute myocardial infarction complicated with an LV thrombus. Both patients were prescribed apixaban 2.5 mg twice daily. Neither patient has experienced LV thrombus or DOAC treatment related complications. This case series serves as evidence for reduced-dose DOACs as an alternative to warfarin in the treatment of LV thrombus.

show abstract

Use of apixaban in children awaiting heart transplantation

Benvenuto,

Hartje‐Dunn,

et al. 2023

Pediatric Transplantation

View full text Add to dashboard Cite

BackgroundThe use of apixaban in the pediatric cardiac population is expanding. We describe our apixaban dosing and monitoring strategy in children and young adults awaiting heart transplantation, along with outcomes related to bleeding and thrombosis during wait‐list and early post‐transplant periods.MethodsThis study is a retrospective, single‐center analysis of all patients receiving apixaban while awaiting cardiac transplantation. Weight‐based dosing was monitored with peak drug‐specific anti‐Xa chromogenic analysis. Significant post‐operative bleeding defined by chest tube output or need for surgical intervention.ResultsFrom September 2020 to December 2022, 19 patients, median age 13.5 years (6.1, 15.8 years), weighing 48.9 kg (15.4, 67.6) received apixaban while awaiting transplant. Indication for apixaban was prophylaxis (n = 18, 3 with ventricular assist devices) and treatment of thrombus (n = 1). There were no clinically relevant non‐major or major bleeding, nor thrombotic events while awaiting transplant. The median time from last apixaban dose to arrival in the operating room was 23.2 h (15.6–33.8), with median random apixaban level of 37 ng/mL (28.3, 59), 6.3 h (4.8, 8.4) prior to arrival in the operating room. In this study, 32% of patients had significant post‐operative bleeding based on chest tube output post‐transplant or need for intervention. No patients meeting criteria for significant post‐operative bleeding were thought to be attributable to apixaban.ConclusionsCareful use of apixaban can be safe and effective while awaiting heart transplant. There was no appreciable increase in peri‐operative bleeding. The use of apixaban is promising in providing safe, predictable and efficacious anticoagulation while avoiding additional patient stressors.

show abstract

Efficacy and safety of direct oral anticoagulants for treatment of left ventricular thrombus; a systematic review

Cited by 6 publications

References 18 publications

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

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

Reduced-Dose Apixaban in the Treatment of Left Ventricular Thrombus: A Report of 2 Cases

Use of apixaban in children awaiting heart transplantation

Contact Info

Product

Resources

About