Bahmaid Reem A, Ammar Shoroq, Al-Subaie Sarah, Soofi Mohammed A, Mhish Hassan, Yahia Madonna Ali
King Fahad Medical City, Riyadh, Saudi Arabia.
Princes NOURA University, Riyadh, Saudi Arabia.
JRSM Cardiovasc Dis. 2019 Apr 8;8:2048004019839548. doi: 10.1177/2048004019839548. eCollection 2019 Jan-Dec.
Left ventricular thrombus is a frequent complication of acute myocardial infarction and a risk factor for thromboembolic complications. Warfarin has been frequently used, but has some disadvantages that limit its use. Direct oral anticoagulants, in particular Dabigatran and Rivaroxaban have been proved to be effective in preventing thromboembolism among patients with non-valvular atrial fibrillation. However, no randomized clinical trials testing the efficacy and safety of these agents in patients with existing left ventricular thrombus. Furthermore, direct oral anticoagulants are still not approved by the Food and Drug Administration in the management of left ventricular thrombus.
This study was a retrospective cohort assessing the efficacy of direct oral anticoagulants (Dabigatran or Rivaroxaban) on the resolution of left ventricular thrombus in patients taking either of these drugs during the study period from December, 2011 to December, 2016 at King Fahad Medical City. All patients' records were reviewed and all patients who were diagnosed with left ventricular thrombus were included. Patients without available echocardiogram records were excluded. The study was approved by the institutional review board of King Fahad medical city, Riyadh Saudi Arabia.
During the defined study period we found that 413 and 1218 patients were taking Dabigatran and Rivaroxaban, respectively. After filtering them based on the specialty of the prescriber, we ended up with 299 patients who have been started on Dabigatran and 448 patients who have been started on Rivaroxaban by cardiologists. Moreover, after reviewing echocardiogram reports for all of them (747 patients), we found that 11 patients were diagnosed to have left ventricular thrombus. Among those 11 patients, seven of them were treated with direct oral anticoagulants from the beginning and the remaining four patients were shifted from Warfarin to direct oral anticoagulants. All of them (7 patients) showed left ventricular thrombus resolution on follow-up echocardiogram.
Use of direct oral anticoagulants showed promising results in the resolution of left ventricular thrombus in patients diagnosed with left ventricular thrombus. Further studies at multiple health care centers are needed to further evaluate the efficacy and safety of direct oral anticoagulants as compared to traditional treatment in patients with left ventricular thrombus.
左心室血栓是急性心肌梗死常见的并发症，也是血栓栓塞并发症的危险因素。华法林一直被广泛使用，但存在一些缺点限制了其应用。直接口服抗凝剂，尤其是达比加群和利伐沙班，已被证明在预防非瓣膜性心房颤动患者血栓栓塞方面有效。然而，尚无随机临床试验测试这些药物对现有左心室血栓患者的疗效和安全性。此外，直接口服抗凝剂在左心室血栓管理方面仍未获得美国食品药品监督管理局的批准。
本研究是一项回顾性队列研究，评估2011年12月至2016年12月在法赫德国王医疗城期间服用直接口服抗凝剂（达比加群或利伐沙班）的患者中，这些药物对左心室血栓溶解的疗效。查阅了所有患者的记录，纳入所有被诊断为左心室血栓的患者。排除没有可用超声心动图记录的患者。该研究获得了沙特阿拉伯利雅得法赫德国王医疗城机构审查委员会的批准。
在规定的研究期间，我们发现分别有413例和1218例患者服用达比加群和利伐沙班。根据开处方医生的专业进行筛选后，最终有299例患者开始服用达比加群，448例患者由心脏病专家开始服用利伐沙班。此外，在查阅了所有这些患者（747例）的超声心动图报告后，我们发现有11例患者被诊断为左心室血栓。在这11例患者中，7例从一开始就接受直接口服抗凝剂治疗，其余4例患者从华法林转换为直接口服抗凝剂。所有患者（7例）在随访超声心动图中均显示左心室血栓溶解。
对于诊断为左心室血栓的患者，使用直接口服抗凝剂在左心室血栓溶解方面显示出有前景的结果。需要在多个医疗中心进行进一步研究，以进一步评估直接口服抗凝剂与传统治疗相比在左心室血栓患者中的疗效和安全性。
