Use of dabigatran for treatment of left ventricular thrombus: A tertiary care center experience

OBJECTIVES: Direct oral anticoagulants (DOACs) are now replacing vitamin K oral anticoagulants (VKAs) owing to superior efficacy, rapid action, less bleeding, wider therapeutic range,and fewer food and drug interactions.Unfortunately, the available data on the use of DOACs, particularly dabigatran, for treatment of left ventricular thrombus (LVT) issparse. We have hereby presented the largest study on use of dabigatran in LVT. METHODS: Retrospective data of patients having LVT as diagnosed by transthoracic echocardiography (TTE) was screened. Patients on dabigatran were included in the study and follow up data of 6 months was obtained through medical records. RESULTS: Of the 15 patients included in the study, the most frequent etiology was ischemic heart disease (67%), including 7 patients of STEMI (47%), followed by non-ischemic cardiomyopathy in 5 patients (33%). Only one patient, with STEMI, developed mild gastrointestinal bleeding at 3 months. Complete clot resolution was seen in 2 patients (13%) at first week of follow up and total 5 patients (33%) at the end of second week. The rate of clot resolution at 1 month, 3 months, and 6 months were 80%, 93% and 100%, respectively. The median duration required for complete clot resolution was 30 days (IQR=14-30). CONCLUSION: Dabigatran appears to be safe, highly efficacious and results in rapid LV clot resolution. DOACs may be a suitable alternative to warfarin in treatment of LV thrombus. However, larger studies are required to validate this hypothesis.