Division of Cardiology, Jean Monnet University, Saint-Etienne Cedex 2, Loire, France.
Service de Cardiologie, Hôpital Nord, Centre Hospitalier Universitaire de Saint-Etienne, 42055, Saint-Etienne Cedex 2, Loire, France.
Clin Drug Investig. 2020 Apr;40(4):343-353. doi: 10.1007/s40261-020-00898-3.
The efficacy of direct oral anticoagulants (DOACs) in the management of left ventricular (LV) thrombi remains to be determined, especially in patients with ischemic cardiomyopathy. This retrospective study sought to compare the efficacy of vitamin K antagonists (VKAs) and DOACs in patients with LV thrombi and evaluate the rate of LV thrombus resolution after adjusting anticoagulation.
This observational retrospective study included patients admitted to our institution for LV thrombus between January 2010 and August 2019. The rate of LV thrombus resolution was compared between VKAs and DOACs. Patients without thrombus resolution with DOAC treatment were switched to VKA agents in order to obtain an international normalized ratio (INR) of 3-4.
Between January 2010 and August 2019, 59 consecutive patients with LV thrombi detected by transthoracic echocardiography were included in the study. The mean age was 62 ± 14 years and 16.9% were women. The circumstances of LV thrombus discovery were as follows: acute myocardial infarction or ischemic myocardiopathy (n = 22), stroke (n = 6), chest pain (n = 7), heart failure (n = 11), transthoracic echocardiographic evaluation (n = 11), and ventricular arrhythmias (n = 2). The proportion of patients on DOACs was 28.8% (n = 17), while that of those on VKAs was 71.2% (n = 42). Thrombus resolution was obtained in 70.6% (12/17) of patients on DOACs and in 71.4% (30/42) of those on VKAs (p = 0.9). Patients who failed to respond to DOAC treatment were treated with VKAs, and following this treatment adjustment all LV thrombi were dissolved in the DOAC group (5/5). Five embolic events (8.4% of stroke) occurred before the treatment initiation and six with anticoagulants (2/17 with DOACs [11.8%] and 4/42 with VKAs [9.5%]; p = 0.8).
This retrospective observational study found a similar efficacy between DOAC and VKA agents in patients with LV thrombi (70.6% vs. 71.5%); however, when the thrombus remains, VKAs are still the standard of care as it is possible to control INR levels (3-4) with them.
直接口服抗凝剂（DOACs）在左心室（LV）血栓管理中的疗效仍有待确定，尤其是在缺血性心肌病患者中。本回顾性研究旨在比较维生素 K 拮抗剂（VKAs）和 DOACs 在 LV 血栓患者中的疗效，并评估调整抗凝治疗后 LV 血栓溶解的发生率。
本观察性回顾性研究纳入了 2010 年 1 月至 2019 年 8 月期间因 LV 血栓而入院的患者。比较了 VKAs 和 DOACs 治疗后 LV 血栓溶解的发生率。在 DOAC 治疗后仍未溶解血栓的患者，为了获得 3-4 的国际标准化比值（INR），将其切换为 VKA 药物。
2010 年 1 月至 2019 年 8 月期间，59 例经胸超声心动图检测到的 LV 血栓患者被纳入本研究。平均年龄为 62±14 岁，16.9%为女性。LV 血栓发现的情况如下：急性心肌梗死或缺血性心肌病（n=22）、中风（n=6）、胸痛（n=7）、心力衰竭（n=11）、经胸超声心动图评估（n=11）和室性心律失常（n=2）。接受 DOAC 治疗的患者比例为 28.8%（n=17），接受 VKAs 治疗的患者比例为 71.2%（n=42）。接受 DOAC 治疗的患者中有 70.6%（12/17）血栓溶解，接受 VKAs 治疗的患者中有 71.4%（30/42）（p=0.9）。对 DOAC 治疗无反应的患者采用 VKAs 治疗，在这种治疗调整后，DOAC 组的所有 LV 血栓均溶解（5/5）。治疗开始前发生了 5 次栓塞事件（8.4%为中风），抗凝治疗后发生了 6 次（2/17 例 DOACs [11.8%]和 4/42 例 VKAs [9.5%]；p=0.8）。
本回顾性观察性研究发现，LV 血栓患者中 DOAC 和 VKA 药物的疗效相似（70.6%比 71.5%）；然而，当血栓仍然存在时，VKAs 仍然是标准治疗方法，因为可以通过它们来控制 INR 水平（3-4）。
