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April 23, 2026Journal of Cardiothoracic SurgeryOpen Access

Baseline LVEF > 30% shows no association with 12-week LV thrombus resolution vs LVEF ≤ 30%.

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Why the study?

Poor LVEF is associated with an increased risk of LV thrombus formation, but its effect on thrombus resolution remains unclear.

Does baseline LVEF ≤ 30% or DOAC use improve the resolution of left ventricular thrombus at 12 weeks in patients on oral anticoagulation?

Population

380 patients with LV thrombus on oral anticoagulation for ≥ 12 weeks

Comparison

LVEF ≤ 30% vs LVEF > 30%

Design

Combined prospective and retrospective cohort study

Follow-up

12 weeks

Key result

Baseline left ventricular ejection fraction > 30% was not significantly associated with left ventricular thrombus resolution at 12 weeks compared to LVEF ≤ 30% after multivariable adjustment (HR 0.79).

Authors

YCYaoyao CaiQYQing YangXQXin Quan

Discussion

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Member takes

Overview

Supports DOAC over warfarin for LV thrombus resolution; leaves open optimal strategy pending randomized trials.

Key Points

  • To determine the effect of left ventricular ejection fraction (LVEF) on left ventricular thrombus resolution after anticoagulation.
  • Enrolled 380 patients with LV thrombus within the last 3 months
  • Measured thrombus resolution at 12 weeks
  • Conducted Cox regression to analyze outcomes
  • Unadjusted results showed higher thrombus resolution in patients with LVEF ≤ 30% (78.5% vs. 63.9%)
  • After adjusting for confounders, LVEF was not a significant predictor of thrombus resolution
  • DOACs were associated with a higher likelihood of thrombus resolution compared to warfarin (HR 1.34)

Study Design

Type

Cohort (n=380)

Blinding

Open-label

Multicenter

No

Structured PICO

Does baseline LVEF ≤ 30% or DOAC use improve the resolution of left ventricular thrombus at 12 weeks in patients on oral anticoagulation?

P
Population
380 patients with left ventricular (LV) thrombus diagnosed within the last 3 months, on oral anticoagulation for ≥ 12 weeks. Median age 50.8 years, 81.6% male. Underlying conditions included dilated cardiomyopathy (51.6%). Median baseline LVEF was 30%.
I
Intervention
Left ventricular ejection fraction (LVEF) ≤ 30% (primary exposure) and Direct Oral Anticoagulants (DOACs) (secondary exposure)
C
Comparator
LVEF > 30% and Warfarin (active comparator for anticoagulation)
O
Outcome
Resolution of LV thrombus at 12 weeks (defined as no identifiable thrombus on imaging)surrogate

Main Result

Effect estimate: HR 0.79 (95% CI 0.61-1.03)

Absolute Event Rate: 63.9% vs 78.5%

p-value: p=0.089

Baseline LVEF does not independently predict LV thrombus resolution at 12 weeks, but DOACs appear more effective than warfarin in promoting resolution.

Limitations

  • Non-randomized design
  • Potential residual confounding

Cite This Study

Cai et al. (2026) conducted a cohort in Left ventricular thrombus (n=380). LVEF > 30% vs. LVEF ≤ 30% was evaluated on Resolution of LV thrombus at 12 weeks (HR 0.79, 95% CI 0.61-1.03, p=0.089). Baseline left ventricular ejection fraction > 30% was not significantly associated with left ventricular thrombus resolution at 12 weeks compared to LVEF ≤ 30% after multivariable adjustment (HR 0.79).

synapsesocial.com/papers/69e9b9a285696592c86ec40fhttps://doi.org/10.1186/s13019-026-04106-9
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