To DOAC or Not to DOAC for Left Ventricular Thrombi—What Is the Dose?

To the Editor The observational study published by Robinson and colleagues (Retrospective Evaluation of DOACs and Vascular Endpoints of Left Ventricular Thrombi [RED VELVT] study)¹ provides important new data to an area that lacks a robust base of evidence. Direct oral anticoagulants (DOACs) have become preferred pharmacotherapy options for adults with nonvalvular atrial fibrillation, given the noninferiority to warfarin for stroke prevention and superior safety profile with less major bleeding.² Although vitamin K antagonists (eg, warfarin) remain preferred in those with mechanical valves, there has been interest in using DOACs off-label for other prothrombotic states, including those with moderate to severe mitral stenosis, suggested by observational data.³