Heart failure & cardiomyopathies
The role of aetiology in determining anticoagulation effectiveness for the treatment of left ventricular thrombus
Authors' conclusion
The underlying aetiology of LV dysfunction significantly influences both treatment response and outcomes in patients with LV thrombus. Direct oral anticoagulant were associated with superior efficacy and safety in AMI-related LV thrombus, but were linked to increased rates of SSE in NICM. These findings highlight the importance of aetiology on LV thrombus management and the potential need for tailored approaches.
Study context
- Population
- Patients with confirmed left ventricular (LV) thrombus treated with either a vitamin K antagonists (VKA) or DOACpatients with confirmed LV thrombus
- Participants
- 901 patients
- Exposure
- DOAC vs. VKA across different aetiologies of LV dysfunction
- Outcome
- Thrombus resolution
Main finding
As reported in the abstract
- Overall, thrombus resolution was significantly higher in DOAC treated patients, but this was driven by the acute myocardial infarction (AMI) sub-group
- P = 0.018
- Direct oral anticoagulant use independently predicted thrombus resolution, OR 2.0 (95% Cl 1.29-3.24)
- P = 0.010
Observational data: associations, not effects.
Secondary outcomes
Principal aetiologies
- AMI
- 38.3%
- Ischaemic cardiomyopathy (ICM)
- 38.0%
- Non-ischaemic cardiomyopathy (NICM)
- 23.7%
Stroke and systemic embolization (SSE)
- Non-ischaemic cardiomyopathy had the highest SSE rate
- 15.3%, P = 0.002
- SSE in NICM significantly raised in those treated with DOAC
- P < 0.001
Safety
Major bleeding events (BARC ≥3)
- More common with VKA use
- P = 0.008
Original publication
The role of aetiology in determining anticoagulation effectiveness for the treatment of left ventricular thrombus. Eur Heart J Cardiovasc Pharmacother. Published 31 December 2025. doi:10.
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