Time in therapeutic range as predictor of early left-ventricular thrombosis resolution: a retrospective cohort study

: Vitamin K antagonists (VKAs) for 3-6 months are the recommended treatment for left-ventricular thrombosis (LVT) to achieve thrombus resolution and reduce the risk of cardioembolic events. The aim of this study was to evaluate the association between quality of VKAs and early-6 months-thrombus resolution in patients with LVT. In this retrospective study, patients with LVT referred to three Italian Anticoagulation Clinics between January 2011 and December 2023 were enrolled if they received VKAs and data on LVT resolution up to 6 months of treatment were available. Primary outcome was the effect of time-in-therapeutic range and of INR variability defined according to validated formulas on early thrombus resolution. Fifty-four patients were included. Median age was 68 years and 87% were male. Overall, 41.7% and 35.4% patients had a reduced or moderately reduced left-ventricle ejection fraction and apical aneurysm. Twenty-three patients (42.6%) had early thrombus resolution. For the prediction of early LVT resolution, the best value of TTR was 56% (sensitivity, 57%; specificity, 71%; AUC, 0.657), that of INR variability, formula A was 1.65 (sensitivity, 0%; specificity, 96%; AUC, 0.478) and that of formula B 0.40 (sensitivity, 4%; specificity, 100%; AUC, 0.599). The cumulative incidence of early LVT resolution was higher in patients with TTR values ≥ 56% (57.1%; 95% confidence interval-CI 32.8-75.5%) than < 56% (30.3%; 95% CI 15.6-46.4%).The quality of VKAs anticoagulation may be a relevant driver for early LVT resolution. TTR evaluation appears to have a slightly greater accuracy compared to INR variability.