Abstract Details

Title Clinical Outcomes of DOACs Versus Warfarin for Ischemic Stroke Caused by Left Ventricular Thrombus

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P11 - Poster Session 11 (11:45 AM-12:45 PM)

Poster/Presentation
Number 4-021

Objective

The objective of this study is to evaluate the relative clinical outcomes of warfarin and direct oral anticoagulant (DOAC) agents for patients who had ischemic stroke due to left ventricular thrombus (LVT).

Background LVT is a leading etiology of cardioembolic stroke, with early appropriate anticoagulation therapy essential. However, there is lack of robust evidence comparing warfarin against direct oral anticoagulants, and the choice of stroke prevention therapy in LVT patients remains based on the personal choice of the individual patient and physician.

Design/Methods

This retrospective observational study included 48 adult patients treated for ischemic stroke secondary to LVT at our institution between 9/2017 and 12/2024. Patients were included if they were anticoagulated with warfarin or a DOAC and had follow-up cardiac imaging to assess thrombus resolution within 6 months of LVT diagnosis; and excluded if on anticoagulation prior to LVT diagnosis. We evaluated rates of LVT resolution and complications by anticoagulant usage.

Results By 6 months, 79% of patients achieved thrombus resolution. Five patients were switched from warfarin to a DOAC over the 6-month period. There was no statistically significant difference in thrombus resolution rates between warfarin, Apixaban, and Rivaroxaban use at initial diagnosis (p = 0.6). However, thrombus resolution was associated with DOAC use at 6 month follow-up (p = 0.07). Warfarin use trended towards a higher rate of complications, with 27.3% of patients experiencing complications compared to 3.8% among DOAC patients; however, overall number of complications was too small to reach statistical significance.

Conclusions These findings suggest that DOACs are non-inferior to warfarin for resolution of LVT by 6 months. Warfarin may be associated with greater complication risk within this time period and more difficulties for patient adherence. These factors should be taken into consideration when selecting an anticoagulant agent for patients diagnosed with LVT.

Authors/Disclosures
Jasmine Zhang, BS PRESENTER	Ms. Zhang has nothing to disclose.
Sophie Nguyen	Miss Nguyen has nothing to disclose.
Faraz Behzadi, MD	Dr. Behzadi has nothing to disclose.
Brigham Harrison	Mr. Harrison has nothing to disclose.
Josephine Martin, DO	Dr. Martin has nothing to disclose.
Judy Dawod, MD (University of Pittsburgh)	Dr. Dawod has nothing to disclose.

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