Evidence map›Paper›PMID 32320043›Full record

ArticleJAMA cardiology2020

Off-label Use of Direct Oral Anticoagulants Compared With Warfarin for Left Ventricular Thrombi.

Austin A Robinson, Cory R Trankle, Grayson Eubanks, Christopher Schumann, Paul Thompson, Ryan L Wallace, Shouri Gottiparthi, Benjamin Ruth, Christopher M Kramer, Michael Salerno and 4 more

Open access · greenAbstract readComparative StudyMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in JAMA cardiology, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 118 papers, 13 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
118citing papers in PubMed, 13 pooled it
27.1field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

118 citing papers in PubMed, 13 syntheses or guidelines pooled it, 245 citations in OpenAlex.

  1. Pooled it
  2. Direct oral anticoagulants or warfarin in patients with left ventricular thrombus after ST-elevation myocardial infarction: a pilot trial and a prespecified meta-analysis of randomised trials.EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology · 2025
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58 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

14 authors at 4 institutions in 1 country.

Austin A RobinsonDivision of Cardiovascular Medicine, Department of Medicine, University of Virginia Health System, Charlottesville.
Cory R TrankleVirginia Commonwealth University Pauley Heart Center, Virginia Commonwealth University, Richmond.
Grayson EubanksDepartment of Medicine, University of North Carolina, Chapel Hill.
Christopher SchumannDivision of Cardiovascular Medicine, Department of Medicine, University of Virginia Health System, Charlottesville.
Paul ThompsonDepartment of Internal Medicine, Scripps Health, La Jolla, California.
Ryan L WallaceVirginia Commonwealth University Pauley Heart Center, Virginia Commonwealth University, Richmond.
Shouri GottiparthiDepartment of Medicine, University of North Carolina, Chapel Hill.
Benjamin RuthDivision of Cardiovascular Medicine, Department of Medicine, University of Virginia Health System, Charlottesville.
Christopher M KramerDivision of Cardiovascular Medicine, Department of Medicine, University of Virginia Health System, Charlottesville.
Michael SalernoDivision of Cardiovascular Medicine, Department of Medicine, University of Virginia Health System, Charlottesville.
Kenneth C BilchickDivision of Cardiovascular Medicine, Department of Medicine, University of Virginia Health System, Charlottesville.
Cody DeenDepartment of Medicine, University of North Carolina, Chapel Hill.
Michael C KontosVirginia Commonwealth University Pauley Heart Center, Virginia Commonwealth University, Richmond.
John DentDivision of Cardiovascular Medicine, Department of Medicine, University of Virginia Health System, Charlottesville.
University of Virginia Health System · USUniversity of North Carolina at Chapel Hill · USVirginia Commonwealth University · USScripps Health · US

Funding

Training in Cardiovascular Imaging ResearchT32EB003841 · NIBIB · UNIVERSITY OF VIRGINIA CHARLOTTESVILLE · PI Jonathan R Lindner · 2004 to 2026
$4.4M
NIBIB NIH HHS T32 EB003841
6 · The paper itself

Abstract

Importance: Left ventricular (LV) thrombi can arise in patients with ischemic and nonischemic cardiomyopathies. Anticoagulation is thought to reduce the risk of stroke or systemic embolism (SSE), but there are no high-quality data on the effectiveness of direct oral anticoagulants (DOACs) for this indication. Objective: To compare the outcomes associated with DOAC use and warfarin use for the treatment of LV thrombi. Design, Setting, and Participants: A cohort study was performed at 3 tertiary care academic medical centers among 514 eligible patients with echocardiographically diagnosed LV thrombi between October 1, 2013, and March 31, 2019. Follow-up was performed through the end of the study period. Exposures: Type and duration of anticoagulant use. Main Outcomes and Measures: Clinically apparent SSE. Results: A total of 514 patients (379 men; mean [SD] age, 58.4 [14.8] years) with LV thrombi were identified, including 300 who received warfarin and 185 who received a DOAC (64 patients switched treatment between these groups). The median follow-up across the patient cohort was 351 days (interquartile range, 51-866 days). On unadjusted analysis, DOAC treatment vs warfarin use (hazard ratio [HR], 2.71; 95% CI, 1.31-5.57; P = .01) and prior SSE (HR, 2.13; 95% CI, 1.22-3.72; P = .01) were associated with SSE. On multivariable analysis, anticoagulation with DOAC vs warfarin (HR, 2.64; 95% CI, 1.28-5.43; P = .01) and prior SSE (HR, 2.07; 95% CI, 1.17-3.66; P = .01) remained significantly associated with SSE. Conclusions and Relevance: In this multicenter cohort study of anticoagulation strategies for LV thrombi, DOAC treatment was associated with a higher risk of SSE compared with warfarin use, even after adjustment for other factors. These results challenge the assumption of DOAC equivalence with warfarin for LV thrombi and highlight the need for prospective randomized clinical trials to determine the most effective treatment strategies for LV thrombi.

Indexed as

Off-Label UseAdministration, OralAnticoagulantsFemaleHeart DiseasesHeart VentriclesHumansMaleMiddle AgedRetrospective StudiesThrombosisWarfarinAnticoagulantsWarfarin

Identifiers

PMID32320043
PMCPMC7177639
OpenAlexW3016802336

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.