Comparative study of the efficacy of direct oral anticoagulants (DOACS) versus vitamin k antagonists (VKAS) in the resolution of left ventricular thrombi at the University Hospital of Tangier: A study of 50 cases

Introduction: Left ventricular (LV) thrombi represent a notable complication of cardiac diseases, particularly ischemic heart disease, significantly increasing the risk of systemic thromboembolic events. Anticoagulant treatment is essential for preventing these complications and promoting thrombus resolution. This study aims to compare the efficacy and safety of direct oral anticoagulants (DOACs) versus vitamin K antagonists (VKAs) in resolving LV thrombi.

Methodology: This retrospective observational study was conducted over two years in the cardiology department at the University Hospital Center (CHU) of Tangier, including 50 patients with echocardiographically confirmed LV thrombus. Exclusion criteria were patients already on anticoagulation therapy, those with atrial fibrillation (AF), or a history of venous thromboembolic events. Patients were divided into two groups (DOACs vs VKAs) and assessed for efficacy (echocardiographic resolution of thrombus at 6 months) and safety (incidence of bleeding and stroke).

Results: Overall mortality from all causes during follow-up was 15%. At six months, thrombus resolution varied depending on the anticoagulant treatment. In the group treated with direct oral anticoagulants (DOACs), complete resolution was observed in 75% of patients, partial resolution in 20%, and no resolution in 5%. In the group treated with vitamin K antagonists (VKAs), complete resolution occurred in 87% of patients, partial resolution in 10%, and no resolution in 3%.

Hemorrhagic complications were reported in both groups. In the DOAC group, minor bleeding, such as gingival bleeding and hematuria, was observed in 17% of patients, while major bleeding, including intracerebral hemorrhage, was recorded in 3%. In the VKA group, minor bleeding occurred in 30% of patients, and major bleeding in 12%. INR instability was noted in 50% of patients receiving VKAs.

Conclusion: VKAs show slightly greater effectiveness in LV thrombus resolution but at the expense of increased bleeding risk. DOACs, with their favorable safety profile, constitute an appropriate therapeutic alternative, especially for patients at high bleeding risk or those who have difficulty maintaining stable INR levels.