Hossam El Benawi: Loading Dose While Treating LVT Could Mitigate Stroke
Hossam El Benawi, Senior Clinical Research Fellow of Cardiovascular Medicine at Mayo Clinic, shared on LinkedIn:
”’Loading Dose’ while treating Left ventricular thrombus could mitigate one of its most serious complication ”stroke”.
While many studies have compared DOACs and VKAs for the treatment of left ventricular thrombus (LVT), there is limited data on whether initiating treatment with a loading dose of DOACs can help prevent embolization.”
Mayo Clinic Multi-Center LVT study about DOAC Loading dose:
All over our study, 10 embolism events (DOAC: 4, VKA: 6).
· 50% of events (5/10) occurred within the first 8 weeks after LVT diagnosis.
Group comparison:
-At 6 months: DOAC 4.3% vs. VKA 1.8% (p = 0.37). Figure A
-All follow up: DOAC 5.7% vs. VKA 5.4% (p = 1.0). Figure B
In a subgroup analysis of patients treated with DOAC, we compared those with and without DOAC loading doses to the VKA group during the first 6 months.
-SSE ( systemic embolic events) incidence: 0% (loaded DOAC) vs. 5.7% (non-loaded DOAC) vs. 1.8% (VKA), p = 0.26. Figure C
-Events: 0/18 (loaded DOAC) vs. 3/52 (non-loaded DOAC) vs. 2/112 (VKA).
Numerically fewer SSE events in DOAC loading group vs. non-loading and VKA, but not statistically significant, likely due to small sample size).
Since 50% of embolization events occurred within the first 8 weeks, predominantly in the non-loading group, these findings suggest that initiating a loading phase early in treatment may be a more appropriate—and more consistent with FDA labeling for acute thrombosis—strategy to reduce SSE in patients with LVT.
Mayo Clinic Multi Center LVT Study, Part 1
Study Link”
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 Elbenawi, 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
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