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Master Thesis

Impact of direct oral anticoagulant therapy on intraventricular thrombus evaluated with cardiac magnetic resonance imaging

Abstract : Left ventricular thrombus (LVT) observed in cardiomyopathy is associated with risks for systemic embolism, morbidity and mortality. Right ventricular thrombus (RVT) is rare but with potential risk of acute pulmonary embolism. Current first-line therapy of intraventricular thrombus (IVT) is vitamin K antagonists (VKA) but with numerous limits regarding efficacy and safety. OBJECTIVE: the purpose of this study was to evaluate the efficacy of direct oral anticoagulants (DOA) therapy on IVT resolution with cardiac magnetic resonance (CMR) evaluation. METHODS: from June 2018 to September 2021, we included patients with IVT diagnosis on transthoracic echography, CMR and/or Computed Tomography (CT) scan and treated with DOA in Montpellier and Nîmes University Hospital. Patients with CMR contra-indications or treated with VKA were excluded. The primary end point was the resolution of IVT on CMR at 6 months follow up and secondary end point included mortality, thromboembolic and bleeding events during the same follow-up. RESULTS: thirty-four patients with a mean age of 58 ±16 years and a majority of male (n=30, 88.2%) were enrolled including 32 LVT and 2 RVT. Ischemic cardiomyopathy was the most common aetiology (n = 30, 88.2%) with mainly patients admitted for anterior STEMI (n=20, 58.8%). RVT was found exclusively in dilated cardiomyopathy with biventricular dysfunction. Patients were treated with apixaban (55.9%), dabigatran (32.4%) or rivaroxaban (11.7%). Antiplatelet therapy was used in 88.2% of the population. IVT resolution was observed at follow-up CMR in 25 (73.5%) patients, 23 (71.9%) LVT and 24 all RVT. Stroke occurred in one patient (2.9%) and severe bleeding (BARC ≥ 3) in one patient (2.9%) at 6 months follow-up. CONCLUSION: in this prospective, observational and multicenter pilot study, DOA therapy was associated with IVT resolution in 73.5% of patients with serious events observed in 5.8% of patients. The preliminary results suggests that DOA are effective in treating IVT with few ischemic and bleeding events. Larger observational data and randomized studies with comparison with VKA will be required to confirm these results.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-03457340
Contributor : Faculté de Médecine Um Connect in order to contact the contributor
Submitted on : Tuesday, November 30, 2021 - 2:56:15 PM
Last modification on : Wednesday, December 8, 2021 - 3:18:11 AM

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  • HAL Id : dumas-03457340, version 1

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Marine Boulanger. Impact of direct oral anticoagulant therapy on intraventricular thrombus evaluated with cardiac magnetic resonance imaging. Human health and pathology. 2021. ⟨dumas-03457340⟩

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