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Poster Networking

Arterial Thromboembolism

PB0006 - Therapeutic management of left ventricular thrombosis with vitamin k antagonists: a multicenter observational study

Sunday, June 23, 2024
13:45 – 14:45 ICT
Room: Exhibition Hall
Background: The optimal duration of anticoagulant therapy in left ventricular thrombosis (LVT) is unknown.

Aims: The aim of our study is to evaluate the effectiveness and safety of vitamin K antagonists (VKAs) until LVT resolution or up to 12 months.

Methods: Patients with LVT receiving VKAs until LVT resolution or for up to 12 months were retrospectively included from 2011 to 2021 at 5 outpatient clinics in Italy. Effectiveness outcomes were on-treatment thrombus resolution, ischemic stroke, myocardial infarction, peripheral embolism, while safety outcomes major and clinically-relevant non-major bleedings at 12-months follow-up. Cumulative incidences of thrombus resolution were calculated and other outcomes were descriptively reported. Multivariable Cox proportional hazards model for thrombus resolution was performed.

Results: A total of 83 patients were included. Baseline characteristics, prevalence of cardiovascular or LVT risk factors did not differ between patients with or without thrombus resolution. Treatment duration was ≤ 3 months in 9.6% of patients, between 3-6 months in 10.9% of patients, and between 6-12 months in 79.5% of patients for a median treatment duration of 12 months. Median time in therapeutic range was 59% and 28.4% of patients received VKA monotherapy. The 3- and 12-month cumulative incidences of thrombus resolution were 36% (95% Confidence Interval -CI-, 26%-46%) and 66% (95% CI, 54%-75%), respectively. The presence of a left ventricular ejection fraction < 50% was associated with a 50% hazard reduction of thrombus resolution (0.51; 95%CI 0.29-0.89; p=0.02). One patient had acute ischemic stroke and one myocardial infarction. Three patients developed a major bleeding and 3 patients a clinically-relevant non-major bleeding.

Conclusion(s): The incidence of LVT resolution was higher at 12 months than at 3 months of follow-up, and the rates of on-treatment acute arterial and bleeding events were low. Reduced left ventricular ejection fraction was associated with a low LVT resolution.