Abstract A040: Clinical outcomes of DOACs versus warfarin for ischemic stroke caused by left ventricular thrombus: a retrospective single-center study

Introduction: Left ventricular thrombus (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 anticoagulant (DOAC) agents, and the choice of stroke prevention therapy in LVT patients remains based on the personal choice of the individual patient and physician. This retrospective study aims to evaluate the relative clinical outcomes of warfarin and DOACs through a comprehensive review of LVT patients with stroke who have been treated with either agent. Methods: This retrospective observational study included 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 either warfarin or a DOAC and had follow-up cardiac imaging to assess thrombus resolution within 6 months of LVT diagnosis. Patients were excluded if they were on anticoagulation prior to LVT diagnosis. Statistical analysis utilized descriptive statistics, t-tests, Mann-whitney tests, and chi-square tests. An alpha level of 0.05 was used to denote statistical significance. Results: Patient demographics and vascular or cardiac risk factors at time of diagnosis did not predict anticoagulant usage type (Table 1). Thrombus resolution increased across the 1-, 3-, and 6-month time points, and 79% of patients achieved resolution by 6 months (Table 2). LVEF also increased across time points, suggesting clinical improvement. 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) (Table 3). 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 with overall numbers 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.