PerspectivesDirect Oral Anticoagulants for the Treatment of Left Ventricular Thrombus—A New Indication? A Meta-summary of Case ReportsTomasoni, Daniela MD; Sciatti, Edoardo MD; Bonelli, Andrea MD; Vizzardi, Enrico MD; Metra, Marco MDAuthor Information Cardiology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health University, Cardiothoracic Department, University of Brescia, ASST Spedali Civili, Brescia, Italy. Reprints: Edoardo Sciatti, MD, Piazzale Spedali Civili, 1, Brescia 25123, Italy (e-mail: email@example.com). The authors report no conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.jcvp.org). Received November 05, 2019 Accepted March 01, 2020 Online date: March 14, 2020 Journal of Cardiovascular Pharmacology: June 2020 - Volume 75 - Issue 6 - p 530-534 doi: 10.1097/FJC.0000000000000826 Buy SDC Metrics Abstract Left ventricular thrombus (LVT) can be a consequence of cardiac diseases such as heart failure with reduced ejection fraction and acute myocardial infarction. Currently, the guidelines recommend the use of warfarin for the treatment of this condition. However, there are increasing reports of patients with LVTs being treated with direct oral anticoagulants (DOACs), for several reasons. We set out to review the available literature to assess the safety and the efficacy of this approach. We analyzed 52 cases, extrapolated by 34 papers contained in literature, focusing on the characteristics of patients, treatment, outcome, and follow-up. Rivaroxaban was the most commonly used DOAC, followed by apixaban. The diagnosis of LVT and the follow-up were mainly performed by transthoracic echocardiography. The thrombus resolved in 45 patients (92%) of 49 (there are no data available regarding the outcome of 3 patients) and failed to resolve in 4 patients treated with DOACs. The resolution occurred in a median of 32 days. DOACs are shown to be a reasonable and valid option for the treatment of LVT. Our study provides a rationale for a prospective randomized controlled trial. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.