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Hossam El Benawi on Comparison of DOACs and VKAs in the Treatment of Left Ventricular Thrombi
Hossam El Benawi/LinkedIn
Oct 8, 2025, 03:04

Hossam El Benawi on Comparison of DOACs and VKAs in the Treatment of Left Ventricular Thrombi

Hossam El Benawi, Senior Clinical Research Fellow of Cardiovascular Medicine at Mayo Clinic, shared on LinkedIn:

”The optimal duration of anticoagulation for left ventricular thrombus (LVT) remains unclear.

The 2022 AHA guidelines recommend treatment with a VKA or DOAC for at least 3–6 months, with longer therapy considered if needed.

However, evidence is limited.

Key questions include:

  • What is the ideal duration of anticoagulation for LVT resolution?
  • Do DOACs and VKAs differ in their effectiveness at resolving LVT?

Insights from our analysis (Mayo Clinic’s Multi-site LVT Study):

At 6 months post-LVT diagnosis, LVT resolution: 61% of patients treated with DOAC vs 61% treated with VKA (p = 1.0). Figure A.

20% of patients on DOAC required longer than 6 months for LVT resolution, compared to 26% of those on VKA ( p=0.31). Figure B.

The median time to LVT resolution was similar (DOAC: 96 days [IQR:67-180] and VKA: 102 days [IQR:68 -199], p = 0.22)

Despite anticoagulation therapy, Persistent LVT was 19.6% of the DOAC group and 13% of the VKA group (p=0.23). Figure B.

These findings suggest that a subset of LVT patients may need prolonged therapy (>6 months), underscoring the importance of tailored treatment strategies based on individual patient clinical characteristics.”

Read the full article here.

Article: Comparison of Direct Oral Anticoagulants and Vitamin K Antagonists in the Treatment of Left Ventricular Thrombi, A Retrospective Cohort Study

Authors: Hossam El Benawi, Kirsten Lipps, Samuel Heller Jr., David A. Liedl, Raymond C. Shields, Ana I. Casanegra, Stanislav Henkin, Thom W. Rooke, Paul W. Wennberg, Waldemar E. Wysokinski, Robert D. McBane, Damon E. Houghton

Hossam El Benawi on Comparison of DOACs and VKAs in the Treatment of Left Ventricular Thrombi

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Ana I. Casanegra Damon E Houghton David A. Liedl DOACs Health Hematology Hemostasis Hemostasis Today Hossam El Benawi Kirsten Lipps Left Ventricular Thrombi LVT Mayo Clinic Medicine Paul W. Wennberg Raymond C. Shields Robert D. McBane Samuel Heller Jr. Stanislav Henkin Thom W. Rooke thrombosis VKAs Waldemar E. Wysokinski
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