Different Oral Antithrombotic Therapy for the Treatment of Ventricular Thrombus: An Observational Study from 2010 to 2019

Abstract

Methods: This retrospective observational study was conducted from 2010 to 2019 in National Center of Cardiovascular Diseases of China. We included patients with VT confirmed by imaging. The primary outcome was the rate of thrombus resolution. Hazard ratio (HR) was calculated with or without adjustment for covariates using Cox proportional hazards regression models.

Results: 463 patients were included. 43.0% received VKAs, 16.6% received NOACs, and 40.4% received APT. Over a median of 468 days' follow-up, NOACs group was more likely to have the thrombus resolved within 12 months' follow-up than VKAs (HR 2.28, 95% CI 1.57 to 3.31) or APT (HR 2.92, 95% CI 1.97 to 4.33). After adjustment for baseline variables, the significance remained in the comparison of NOACs versus VKAs (HR 2.13, 95% CI 1.41 to 3.22) as well as NOACs versus APT (HR 2.55, 95% CI 1.53 to 4.27). No significant differences were identified in bleeding rate, thromboembolism rate, or all-cause death in 12 months' follow-up.

Conclusion: Our findings showed that patients who were male, diagnosed with MI with or without ventricular aneurysm, or diagnosed with coronary artery diseases medical history had a risk of thrombus unresolved. Patients with NOACs had a higher resolution and a similar safety profile comparing VKAs or APT, which persisted after adjusting for other factors. Large randomized controlled trials are required urgently. This trial is registered with NCT05006677.

Conflict of interest statement

The authors report no relationships that could be construed as conflicts of interest.

Copyright © 2022 Qing Yang et al.

Figures

Figure 1

Flow diagram to show patient inclusion and exclusion criteria. 610 patients were found with VT and 463 were included in our analysis: 199 received VKAs, 77 received NOACs, and 187 received antiplatelet therapy. A total of 212 patients had the follow-up image: 53 in NOACs, 92 in VKAs, and 67 in antiplatelet therapy. VT: ventricular thrombus; N: number of patients; NOACs: non-vitamin K antagonist oral anticoagulants; VKAs: vitamin K antagonists.

Figure 2

The number of discharged patients (left axes, blue column) and the proportion of ventricular thrombus patients (right axes, line chart).

Figure 3

Bar chart comparing rates of thrombus resolution in patients with different antithrombotic therapy. A significant unadjusted difference in rates of resolution was observed among patients on NOACs, VKAs, and APT at 6 weeks' (p = 0.0005), 12 weeks' (p = 0.0032), and 6 months' (p = 0.0844) follow-up, while there was no difference at 12 months' (p = 0.3515) follow-up. VT: ventricular thrombus; NOACs: non-vitamin K antagonist oral anticoagulants; VKAs: vitamin K antagonists; APT: antiplatelet therapy.

Figure 4

Cumulative event probability curve for thrombus resolution of NOACs, VKAs, and APT. Kaplan–Meier method was used to calculate the cumulative event probability of three antithrombotic agents and the time was coded in days from the date of first diagnosis of VT to the date of complete resolution of VT in patients with VT. Log-rank test was used to compare the cumulative event among groups (p < 0.0001). VT: ventricular thrombus; NOACs: non-vitamin K antagonist oral anticoagulants; VKAs: vitamin K antagonists; APT: antiplatelet therapy.