Anticoagulantes orales directos frente a warfarina en el trombo del ventrículo izquierdo

AIMS: Left ventricular (LV) thrombus carries a high risk of death and systemic embolism. While warfarin has been the standard treatment, evidence comparing direct oral anticoagulants (DOACs) with warfarin in this setting remains limited. This study aimed to compare real-world, risk-adjusted outcomes of DOAC vs. warfarin use in patients with LV thrombus. METHODS AND RESULTS: We conducted a retrospective cohort analysis using the TriNetX research network database. Adults (≥18 years) with echocardiographically confirmed LV thrombus from 2016 to 2022 were included. Patients with atrial fibrillation/flutter, venous thromboembolism, end-stage renal disease, mechanical/bioprosthetic valves, or therapy switch during follow-up were excluded. Propensity score matching (1:1) was used to balance covariates. The primary outcome was a composite of all-cause mortality and stroke/transient ischaemic attack at 30 days and 1 year. Secondary outcomes included major bleeding and LV thrombus resolution. Of 2488 eligible patients (DOAC: 950; warfarin: 1538), 945 matched pairs were analysed with all baseline covariates balanced. In the DOAC group, 74% received apixaban and 26% rivaroxaban. At 30 days and 1 year, the composite outcome did not differ significantly between DOAC and warfarin [13.3% vs. 15%; matched hazard ratio (HR): 0.90, P = 0.41, and 23.8% vs. 26.7%; matched HR: 0.93, P = 0.46, respectively]. Major bleeding rates were similar at 30 days and 1 year (1.18% vs. 1.54%; matched HR: 0.77, P = 0.54, and 4.8% vs. 4.7%; matched HR: 1.13, P = 0.58, respectively). Thrombus resolution at 6 months occurred in ∼81% of patients with follow-up imaging, with no difference by treatment group. CONCLUSION: In a large propensity-matched cohort, DOACs and warfarin demonstrated comparable effectiveness and safety for LV thrombus management, supporting DOACs as a reasonable alternative.

Resumen tomado de PubMed (NCBI) para el registro citado, en el idioma original. La versión de referencia es la de la publicación original.

El resumen se deja sin traducir para conservar la redacción original de los autores.

Cohorte retrospectiva (red TriNetX) de 2488 adultos con trombo ventricular izquierdo; tras emparejamiento 1:1 quedaron 945 parejas (grupo ACOD: 74 % apixabán, 26 % rivaroxabán). El desenlace combinado (mortalidad por cualquier causa, ictus/AIT) no difirió significativamente a los 30 días (13,3 % vs. 15 %; HR 0,90; p = 0,41) ni al año (23,8 % vs. 26,7 %; HR 0,93; p = 0,46); la hemorragia mayor fue similar. Para los autores, ACOD y warfarina tienen eficacia y seguridad comparables.

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