LVT after acute myocardial infarction (AMI) confers a high risk of stroke and systemic embolism, making anticoagulation selection clinically important. A meta-analysis published in Circulation compared DOACs with warfarin for thrombus resolution and safety outcomes in patients with LVT.

The analysis included 7 randomized controlled trials comprising 554 patients, of whom 319 (58%) received DOACs. Outcomes included LVT resolution at 1 and 3 months and safety endpoints such as major bleeding, stroke or systemic embolism, and all-cause mortality.

At 1 month, LVT resolution occurred in 31.1% of patients treated with DOACs and 26.9% of those treated with warfarin, with no significant difference between groups (odds ratio 1.69; 95% confidence interval 0.62-4.60; p = 0.31). By 3 months, resolution rates increased to 88.2% with DOACs and 81.1% with warfarin, again without a statistically significant difference (odds ratio 1.39; 95% confidence interval 0.83–2.34; p = 0.22).

Safety outcomes were comparable between treatment strategies. Major bleeding did not differ significantly (odds ratio 0.51; 95% confidence interval 0.18–1.48), nor did stroke or systemic embolism (odds ratio 0.69; 95% confidence interval 0.10–4.64) or all-cause mortality (odds ratio 0.88; 95% confidence interval 0.34–2.29).

These findings indicate that DOACs provide efficacy and safety comparable to warfarin for the treatment of LVT after AMI. Larger trials using standardized imaging and anticoagulation protocols are needed to further define their role.