PB0443 - Direct Oral Anticoagulants compared with Warfarin for the Treatment of Left Ventricular Thrombosis post Myocardial Infarction

Sunday, July 10, 2022

6:30 PM – 7:30 PM

Location: Exhibition

Presentation Format: In-Person

Presenting Author(s)

Rosalind A. Byrne

Principal Pharmacist Anticoagulation
King's College Hospital NHS Foundation Trust
London, England, United Kingdom

Co-Author(s)

Julia Czuprynska, MBBS MRCP FRCPath

Haematology Consultant
King's College Hospital
London, England, United Kingdom
VS

Victoria Speed

Senior anticoagulation/research pharmacist
King's College Hospital
London, England, United Kingdom
JB

Jonathan Byrne

Cardiology Consultant
King's College Hospital
London, England, United Kingdom
PS

Paul Scott

Cardiology Consultant
King's College Hospital
London, England, United Kingdom
Rachel E. Clapham, MPharm

Anticoagulation Pharmacist
King's College Hospital NHS Foundation Trust
London, England, United Kingdom
RP

Raj K. Patel

Haematology Consultant
Kings College Hospital
London, England, United Kingdom
Lara N. Roberts, MD

Haematology Consultant
King's College Hospital NHS Foundation Trust
London, England, United Kingdom
Roopen Arya, MA PhD FRCP FRCPath

Professor of Thrombosis and Haemostasis
King's College Hospital NHS Foundation Trust
London, England, United Kingdom
JP

Jig Patel

Honorary Consultant Pharmacist
King's College Hospital NHS Foundation Trust
London, England, United Kingdom

Background: Left ventricular thrombus (LVT) is a major complication of acute myocardial infarction (AMI). Until recently anticoagulation with a vitamin K antagonist has been the mainstay of treatment for LVT. DOACs provide a more acceptable form of anticoagulation however, outcome data on their use in LVT post AMI is limited.

Aims: To compare efficacy and safety of DOACs versus warfarin for patients diagnosed with LVT post AMI at King’s College Hospital, London.

Methods: Patients diagnosed with LVT post AMI between 1st January 2018 and 31st December 2020 were identified using the CogStack search tool. A retrospective case note review was conducted and each patient followed for 1 year after the index event. The primary endpoint was resolution of LV thrombus on repeat imaging, with secondary endpoints of bleeding (major bleed [MB] and clinically relevant non-major bleed [CRNMB]) or stroke or systemic embolism (SSE).

Results: Fifty-seven patients were diagnosed with an LVT post AMI (warfarin 72% and DOAC 28% - rivaroxaban, apixaban or edoxaban). Baseline characteristics were mostly well matched (Table 1). 89% of patients received concurrent dual antiplatelet therapy. The overall rate of thrombus resolution was 75% at first follow up imaging (table 1). Thrombus resolution in the warfarin group was 71% compared with 85% in the DOAC group (p=0.47). There were two SSE events, 1 in the warfarin and 1 in the DOAC group. There were 4 episodes of MB or CRNMB in the warfarin group, and none in the DOAC group (Table 2). There were two minor bleeding events, 1 in the warfarin group and 1 in the DOAC group. The overall difference in documented bleeding was not statistically significant (p=0.66).

Conclusion(s): Our data suggests that DOACs are as safe and effective as warfarin for the treatment of LVT associated with AMI and supports further widespread use for this indication.