Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved. Efficacy of direct oral anticoagulants on left ventricular thrombus O ¨ zge Turgay Yıldırım a , Ercan Aks ¸it b , Fatih Aydın a and Ays ¸e Hu ¨ seyinog ˘ lu Aydın a Left ventricular thrombus (LVT) is a commonly seen complication of myocardial infarction and it also can be seen because of hypertrophic cardiomyopathies, nonischemic dilated cardiomyopathies, malignancies, and so on. Guidelines suggest the use of warfarin for left ventricular thrombi, but recent case reports show that direct oral anticoagulants (DOACs) are beginning to be used for this complication. DOACs are strong alternatives for warfarin because of their efficacy and safety even though there is no randomized controlled trial that proves the effect of DOACs against LVT. In this article, we gather the case reports of DOACs against left ventricular thrombi in various conditions. Blood Coagul Fibrinolysis 30:96–103 Copyright ß 2019 Wolters Kluwer Health, Inc. All rights reserved. Blood Coagulation and Fibrinolysis 2019, 30:96–103 Keywords: apical thrombus, apixaban, dabigatran, left ventricular thrombus, rivaroxaban a Department of Cardiology, Eskisehir State Hospital, Eskisehir and b Department of Cardiology, Canakkale Onsekiz Mart University, C ¸ anakkale, Turkey Correspondence to O ¨ zge Turgay Yıldırım, MD, C ¸ amlıca Mah, Gu ¨ fte Sokak Natura Evleri A1 Blok Daire 3Tepebas ¸ı/Eskis ¸ehir Tel: +905326876626; e-mail: ozgeturgay@gmail.com Received 17 October 2018 Revised 21 January 2019 Accepted 19 February 2019 Introduction Left ventricular thrombus (LVT) is a complication of vari- ous cardiovascular diseases. It mostly occurs after anterior myocardial infarction (AMI) or at patients with dilated cardiomyopathy [1]. In the prereperfusion era, the risk of LVT after AMI was around 40% [2,3] but first thrombolytic treatment strategies and now primary percutaneous coro- nary intervention further decreased the incidence of LVT [4–7]. But still approximately 5–15% of AMI patients are predicted to be at risk of developing LVT in the 3–6 months after the occasion [5,6,8,9]. Patients with low ventricular ejection fraction (<40%), anterior wall akinesia or dyskine- sia, are under higher risk of developing LVT [10]. LVT increases the risk of systemic embolization, espe- cially in the 3–4 months after thrombus detection the incidence of embolism is around 11% [11,12]. ESC guideline for the management of acute myocardial infarc- tion in patients presenting with ST-segment elevation published in 2012 suggests the use of vitamin K antago- nist therapy for 3 months for patients presenting with LVT [13]. Also, American College of Cardiology Foun- dation/American Heart Association Guideline for the Management of ST-Elevation Myocardial Infarction sug- gests vitamin K antagonist therapy for 6 months for patients with LVT and under risk for LVT, such as patients with anterior wall dyskinesia or akinesia [14]. Warfarin is the standard anticoagulation therapy for LVT but this practice is based on mostly the publications conducted at the thrombolysis era in AMI patients [12,15]. The latest study that guides the ESC guideline was published at 1996. This study suggests warfarin use for 3–6 months and has no suggestions for chronic LVT [16]. Vaitkus et al. performed a meta-analysis about vitamin K antagonists and effects on LV thrombosis and systemic embolization at 1993 [12]. Anticoagulation decreased the risk of LV thrombus formation and embo- lization for large anterior MI patients [12]. Warfarin has disadvantages like multiple food and drug interactions, narrow therapeutic range for effective and well-tolerated treatment, and slow onset of action [13,15]. Unlike warfarin, direct oral anticoagulants (DOAC) do not require routine monitoring; they have a rapid onset of action and have lower risk of life-threatening bleeding and intracranial bleeding [17]. Even though DOACs are not approved by Food and Drug Administration, there has been an increasing trend of using DOACs for LVT treatment. With this study, we evaluated published cases of patients with LVT under DOAC treatment and inter- preted the results of the cases (18–51). At the end, we organized a meta-summary to evaluate the performance of DOAC use for the treatment of LVT. Methods Published articles were searched from PubMed, EMBASE, Scopus, and Google Scholar from inception until June 01, 2018. ‘Dabigatran’, ‘Apixaban,’ ‘Rivarox- aban,’ ‘Edoxaban,’ ‘left ventricular thrombus,’ ‘apical thrombus,’ ‘intraventricular thrombus,’ and combination of these terms are used as keywords. Conference abstracts, case reports from reference list of the relevant articles, and reviews also added to the study. There were no data about edoxaban and LVT in the literature search. Results Results of dabigatran on left ventricular thrombus Literature research revealed nine case reports, one case series, and one poster presentation about dabigatran and 96 Review article/Proposal 0957-5235 Copyright ß 2019 Wolters Kluwer Health, Inc. All rights reserved. DOI:10.1097/MBC.0000000000000801