Efficacy and safety of off-label direct oral anticoagulants vs. warfarin for left ventricular thrombus: an inverse probability of treatment weighting analysis
ObjectiveTo evaluate the efficacy and safety of using off-label direct oral anticoagulants (DOACs) compared to warfarin for treating left ventricular (LV) thrombi using inverse probability-of-treatment weighting (IPTW) analysis.MethodsAn observational study of 302 eligible patients with newly diagno...
Saved in:
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2025-04-01
|
| Series: | Frontiers in Cardiovascular Medicine |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2025.1465866/full |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850140498301288448 |
|---|---|
| author | Taha Al-Maimoony Khairallah Al-Matari Abdulhafeedh Al-Habeet Nouradden Noman Aljaber Mohamad Al-Marwala Salah Al-Hashmi |
| author_facet | Taha Al-Maimoony Khairallah Al-Matari Abdulhafeedh Al-Habeet Nouradden Noman Aljaber Mohamad Al-Marwala Salah Al-Hashmi |
| author_sort | Taha Al-Maimoony |
| collection | DOAJ |
| description | ObjectiveTo evaluate the efficacy and safety of using off-label direct oral anticoagulants (DOACs) compared to warfarin for treating left ventricular (LV) thrombi using inverse probability-of-treatment weighting (IPTW) analysis.MethodsAn observational study of 302 eligible patients with newly diagnosed LV thrombi was conducted at a tertiary referral center from January 2020 to December 2023. Of the 302 patients, 183 received treatment with DOACs, while 119 were treated with warfarin. The primary endpoint was defined as the complete resolution of the thrombus within one month. The secondary endpoints were defined as the complete resolution of the thrombus within six months along with the following events, including minor and major bleeding events, a systemic embolism, transient ischemic attack, stroke, and all-cause mortality. Alongside individual endpoints, a composite endpoint involving ischemic stroke or mortality was also examined.ResultsIPTW estimates suggested that DOACs were significantly more effective than warfarin in resolving LV thrombus within one month (RR: 1.38; 95% CI: 1.14–1.66; p-value: <0.001). However, there were no significant differences between the two groups in all secondary endpoints, except that DOACs were significantly associated with a lower incidence of the composite outcome of ischemic stroke and all-cause mortality (RR: 0.96; 95% CI: 0.93–0.99; p-value: 0.040). In DOAC subgroup analysis, only rivaroxaban demonstrated earlier and superior resolution of LV thrombus with non-inferior safety when compared to warfarin.ConclusionsDOACs, specifically rivaroxaban, could be a promising therapeutic alternative for treating LV thrombi. Further research through randomized clinical trials is necessary to confirm our findings. |
| format | Article |
| id | doaj-art-8b7aeb50f5a0432e9422b01f1da0e644 |
| institution | OA Journals |
| issn | 2297-055X |
| language | English |
| publishDate | 2025-04-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj-art-8b7aeb50f5a0432e9422b01f1da0e6442025-08-20T02:29:46ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2025-04-011210.3389/fcvm.2025.14658661465866Efficacy and safety of off-label direct oral anticoagulants vs. warfarin for left ventricular thrombus: an inverse probability of treatment weighting analysisTaha Al-Maimoony0Khairallah Al-Matari1Abdulhafeedh Al-Habeet2Nouradden Noman Aljaber3Mohamad Al-Marwala4Salah Al-Hashmi5Department of Cardiology, Faculty of Medicine, Sana’a University, Sana’a, YemenDepartment of Internal Medicine, Faculty of Medicine and Health Sciences, Amran University, Amran, YemenDepartment of Epidemiology and Biostatistics, Faculty of Medical Sciences, Al-Razi University, Sana’a, YemenDepartment of Cardiology, Faculty of Medicine, Sana’a University, Sana’a, YemenDepartment of Cardiology, Faculty of Medicine and Health Sciences, Amran University, Amran, YemenDepartment of Cardiology, Faculty of Medicine and Health Sciences, Amran University, Amran, YemenObjectiveTo evaluate the efficacy and safety of using off-label direct oral anticoagulants (DOACs) compared to warfarin for treating left ventricular (LV) thrombi using inverse probability-of-treatment weighting (IPTW) analysis.MethodsAn observational study of 302 eligible patients with newly diagnosed LV thrombi was conducted at a tertiary referral center from January 2020 to December 2023. Of the 302 patients, 183 received treatment with DOACs, while 119 were treated with warfarin. The primary endpoint was defined as the complete resolution of the thrombus within one month. The secondary endpoints were defined as the complete resolution of the thrombus within six months along with the following events, including minor and major bleeding events, a systemic embolism, transient ischemic attack, stroke, and all-cause mortality. Alongside individual endpoints, a composite endpoint involving ischemic stroke or mortality was also examined.ResultsIPTW estimates suggested that DOACs were significantly more effective than warfarin in resolving LV thrombus within one month (RR: 1.38; 95% CI: 1.14–1.66; p-value: <0.001). However, there were no significant differences between the two groups in all secondary endpoints, except that DOACs were significantly associated with a lower incidence of the composite outcome of ischemic stroke and all-cause mortality (RR: 0.96; 95% CI: 0.93–0.99; p-value: 0.040). In DOAC subgroup analysis, only rivaroxaban demonstrated earlier and superior resolution of LV thrombus with non-inferior safety when compared to warfarin.ConclusionsDOACs, specifically rivaroxaban, could be a promising therapeutic alternative for treating LV thrombi. Further research through randomized clinical trials is necessary to confirm our findings.https://www.frontiersin.org/articles/10.3389/fcvm.2025.1465866/fulldirect oral anticoagulantsleft ventricular thrombuswarfarinvitamin K antagonistinverse probability of treatment weighting analysis |
| spellingShingle | Taha Al-Maimoony Khairallah Al-Matari Abdulhafeedh Al-Habeet Nouradden Noman Aljaber Mohamad Al-Marwala Salah Al-Hashmi Efficacy and safety of off-label direct oral anticoagulants vs. warfarin for left ventricular thrombus: an inverse probability of treatment weighting analysis Frontiers in Cardiovascular Medicine direct oral anticoagulants left ventricular thrombus warfarin vitamin K antagonist inverse probability of treatment weighting analysis |
| title | Efficacy and safety of off-label direct oral anticoagulants vs. warfarin for left ventricular thrombus: an inverse probability of treatment weighting analysis |
| title_full | Efficacy and safety of off-label direct oral anticoagulants vs. warfarin for left ventricular thrombus: an inverse probability of treatment weighting analysis |
| title_fullStr | Efficacy and safety of off-label direct oral anticoagulants vs. warfarin for left ventricular thrombus: an inverse probability of treatment weighting analysis |
| title_full_unstemmed | Efficacy and safety of off-label direct oral anticoagulants vs. warfarin for left ventricular thrombus: an inverse probability of treatment weighting analysis |
| title_short | Efficacy and safety of off-label direct oral anticoagulants vs. warfarin for left ventricular thrombus: an inverse probability of treatment weighting analysis |
| title_sort | efficacy and safety of off label direct oral anticoagulants vs warfarin for left ventricular thrombus an inverse probability of treatment weighting analysis |
| topic | direct oral anticoagulants left ventricular thrombus warfarin vitamin K antagonist inverse probability of treatment weighting analysis |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2025.1465866/full |
| work_keys_str_mv | AT tahaalmaimoony efficacyandsafetyofofflabeldirectoralanticoagulantsvswarfarinforleftventricularthrombusaninverseprobabilityoftreatmentweightinganalysis AT khairallahalmatari efficacyandsafetyofofflabeldirectoralanticoagulantsvswarfarinforleftventricularthrombusaninverseprobabilityoftreatmentweightinganalysis AT abdulhafeedhalhabeet efficacyandsafetyofofflabeldirectoralanticoagulantsvswarfarinforleftventricularthrombusaninverseprobabilityoftreatmentweightinganalysis AT nouraddennomanaljaber efficacyandsafetyofofflabeldirectoralanticoagulantsvswarfarinforleftventricularthrombusaninverseprobabilityoftreatmentweightinganalysis AT mohamadalmarwala efficacyandsafetyofofflabeldirectoralanticoagulantsvswarfarinforleftventricularthrombusaninverseprobabilityoftreatmentweightinganalysis AT salahalhashmi efficacyandsafetyofofflabeldirectoralanticoagulantsvswarfarinforleftventricularthrombusaninverseprobabilityoftreatmentweightinganalysis |