Paiva Mariana Sousa, Gama Francisco, Azevedo Samuel, Lopes Pedro M, Albuquerque Francisco, Reis Carla, Freitas Pedro, Guerreiro Sara, Abecasis João, Trabulo Marisa, Ferreira António M, Ribeiras Regina, Ferreira Jorge, Pulido Adragão Pedro
Department of Cardiology, Hospital Santa Cruz, Unidade Local de Saúde Lisboa Ocidental, 2790-134 Carnaxide, Portugal.
Hospital da Luz Saúde, 1500-650 Lisbon, Portugal.
J Clin Med. 2025 Mar 20;14(6):2129. doi: 10.3390/jcm14062129.
Left ventricular thrombus (LVT) is a common complication of myocardial infarction (MI) and heart failure with reduced ejection fraction (HFrEF), typically managed with vitamin K antagonists (VKAs) for up to six months. However, data on direct oral anticoagulants (DOACs) for LVT treatment remain limited and conflicting. This study evaluates the effectiveness and safety of DOACs compared to warfarin for LVT resolution. : We conducted a single-center retrospective cohort study of consecutive patients diagnosed with LVT from January 2010 to May 2024. The primary outcome was LVT resolution at 24 months. Safety outcomes included major bleeding and thromboembolic events. Diagnosis and follow-up were performed via echocardiography, with cardiac magnetic resonance and computed tomography as needed. Anticoagulant type, dose, duration, and concurrent antiplatelet therapy were at the treating physician's discretion. : Among 171 patients (82.5% male, mean age 59.8 ± 14.7 years), 99 received DOACs and 72 received warfarin. LVT resolution was higher with DOACs (66.7% vs. 50%, HR 2.0, 95% CI 1.07-3.73, = 0.029), with a trend toward faster thrombus resolution (185 vs. 220 days, = 0.214) though statistically not significant. DOAC use remained an independent predictor of LVT resolution, regardless of antiplatelet use. Major bleeding (2.9%), thromboembolic events (5.3%), and mortality (5.3%) were similar between groups. : DOAC therapy was associated with higher LVT resolution rates and a comparable safety profile to warfarin. Further randomized clinical trials are warranted to validate these findings.
左心室血栓（LVT）是心肌梗死（MI）和射血分数降低的心力衰竭（HFrEF）的常见并发症，通常使用维生素K拮抗剂（VKA）治疗长达六个月。然而，关于直接口服抗凝剂（DOAC）用于LVT治疗的数据仍然有限且存在矛盾。本研究评估了DOAC与华法林相比在LVT溶解方面的有效性和安全性。：我们对2010年1月至2024年5月期间连续诊断为LVT的患者进行了单中心回顾性队列研究。主要结局是24个月时LVT溶解。安全性结局包括大出血和血栓栓塞事件。通过超声心动图进行诊断和随访，必要时进行心脏磁共振和计算机断层扫描。抗凝剂类型、剂量、持续时间和联合抗血小板治疗由治疗医生决定。：在171例患者中（男性占82.5%，平均年龄59.8±14.7岁），99例接受DOAC治疗，72例接受华法林治疗。DOAC治疗的LVT溶解率更高（66.7%对50%，HR 2.0，95%CI 1.07 - 3.73，P = 0.029），血栓溶解有更快的趋势（185天对220天，P = 0.214），尽管在统计学上不显著。无论是否使用抗血小板药物，DOAC的使用仍然是LVT溶解的独立预测因素。两组之间的大出血（2.9%）、血栓栓塞事件（5.3%）和死亡率（5.3%）相似。：DOAC治疗与更高的LVT溶解率相关，且安全性与华法林相当。有必要进行进一步的随机临床试验来验证这些发现。
