Comparison between DOACs and warfarin for left atrial thrombus in atrial fibrillation patients

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature Pub Date : 2025-07-08 DOI:10.1016/j.ijcha.2025.101745

Akihiro Sunaga , Daisaku Nakatani , Katsuki Okada , Hirota Kida , Yuki Matsuoka , Daisuke Sakamoto , Tetsuhisa Kitamura , Nobuaki Tanaka , Yasuyuki Egami , Masaharu Masuda , Tetsuya Watanabe , Hitoshi Minamiguchi , Takafumi Oka , Koichi Inoue , Shungo Hikoso , Yohei Sotomi , Yasushi Sakata

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引用次数: 0

Abstract

Background

Atrial fibrillation (AF) is a major risk factor for thromboembolic events, with left atrial thrombus (LAT) formation occurring despite oral anticoagulant (OAC) therapy in some patients. Direct oral anticoagulants (DOACs) have demonstrated efficacy in preventing thrombosis; however, their role in LAT resolution compared to warfarin remains unclear.

Methods

This retrospective, multicenter study analyzed 260 AF patients with transesophageal echocardiography (TEE)-confirmed LAT among 17,436 AF patients who underwent TEE. Patients were categorized into DOAC and warfarin groups. LAT resolution, ischemic stroke/systemic embolism, major bleeding, and all-cause death were evaluated. The warfarin group was further stratified by time in therapeutic range (TTR) (<60 % and ≥ 60 %), and the DOAC group by dose (standard and low).

Results

During a median follow-up of 386 [367, 413] days, LAT resolution was achieved in 62 % of patients, significantly higher in the DOAC group (74 % vs. 54 %, P = 0.001). Standard-dose DOACs had the highest resolution rates, while TTR < 60 % had the lowest (79 % vs. 49 %). DOACs were independently associated with higher LAT resolution (OR = 2.91 [1.32–6.38], P = 0.008) and fewer bleeding events (OR = 0.26 [0.08–0.80], P = 0.019).

Conclusions

DOAC therapy was associated with higher LAT resolution rates and showed a fewer bleeding events compared to warfarin. DOACs may serve as first-line therapy for LAT.

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DOACs与华法林治疗房颤左房血栓的比较

背景：房颤（AF）是血栓栓塞事件的主要危险因素，在一些患者中，尽管口服抗凝剂（OAC）治疗，仍会形成左房血栓（LAT）。直接口服抗凝剂（DOACs）已被证明具有预防血栓形成的功效；然而，与华法林相比，它们在LAT解决中的作用尚不清楚。方法本回顾性、多中心研究分析了17436例房颤患者中经食管超声心动图（TEE）证实的LAT患者260例。患者分为DOAC组和华法林组。评估LAT消退、缺血性卒中/全身性栓塞、大出血和全因死亡。华法林组按治疗时间（TTR）（≤60%和≥60%）和DOAC组按剂量（标准和低剂量）进一步分层。结果在中位随访386[367,413]天期间，62%的患者获得了LAT缓解，DOAC组明显高于前者（74%对54%，P = 0.001）。标准剂量doac的分辨率最高，而TTR <；60%的人最低（79%对49%）。DOACs与更高的LAT分辨率（OR = 2.91 [1.32-6.38], P = 0.008）和更少的出血事件（OR = 0.26 [0.08-0.80], P = 0.019）独立相关。结论与华法林相比，doac治疗与更高的LAT解决率相关，出血事件较少。DOACs可作为LAT的一线治疗。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

IJC Heart and Vasculature Medicine-Cardiology and Cardiovascular Medicine

CiteScore

4.90

自引率

10.30%

发文量

216

审稿时长

56 days

期刊介绍： IJC Heart & Vasculature is an online-only, open-access journal dedicated to publishing original articles and reviews (also Editorials and Letters to the Editor) which report on structural and functional cardiovascular pathology, with an emphasis on imaging and disease pathophysiology. Articles must be authentic, educational, clinically relevant, and original in their content and scientific approach. IJC Heart & Vasculature requires the highest standards of scientific integrity in order to promote reliable, reproducible and verifiable research findings. All authors are advised to consult the Principles of Ethical Publishing in the International Journal of Cardiology before submitting a manuscript. Submission of a manuscript to this journal gives the publisher the right to publish that paper if it is accepted. Manuscripts may be edited to improve clarity and expression.