Warfarin Versus Direct Oral Anticoagulants For Left Ventricular Thrombus After Myocardial Infarction: A Propensity-Matched Analysis

Document Type

Conference Proceeding

Publication Date

4-7-2026

Publication Title

Journal of the American College of Cardiology

Abstract

BACKGROUND Direct oral anticoagulants (DOACs) are better than warfarin in managing conditions such as atrial fibrillation and venous thromboembolism. However, studies comparing their use in left ventricular (LV) thrombus after myocardial infarction (MI) remain limited. METHODS We used TriNetX to identify adult patients with new-onset LV thrombus within six months after acute MI. Patients were grouped into two mutually exclusive groups based on anticoagulant therapy: warfarin vs. DOAC. All patients received at least one concomitant antiplatelet. We excluded those with prior intracardiac thrombus. One-year clinical outcomes were all-cause mortality, all-cause hospitalization, ischemic stroke, major bleeding (intracranial or gastrointestinal), and systemic embolism. RESULTS A total of 1,095 eligible patients were identified, of whom 37.5% received warfarin. After propensity score matching, 371 patients were in each group (warfarin: age 65.4 ± 13.5 years, 28.3% female; DOAC: age 65.0 ± 12.6 years, 27.8% female). Outcomes were similar between groups, including all-cause mortality (18.3% vs 20.5%), hospitalization (58.8% vs 63.3%), ischemic stroke (13.5% vs 12.9%), major bleeding (10.0% vs 6.7%), and systemic embolism (3.2% vs 3.8%) (all P > 0.05). CONCLUSION One-year outcomes were similar between warfarin and DOAC therapy for LV thrombus after MI. Further prospective studies are needed to confirm these findings and guide anticoagulant selection in this setting.

Volume

87

Issue

13 Suppl

First Page

A821

Comments

American College of Cardiology 75th Annual Scientific Session & Expo, March 28-30, 2026, New Orleans, LA

Last Page

A821

DOI

10.1016/j.jacc.2026.02.4919

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