ORIGINAL RESEARCH article
Front. Med.
Sec. Hematology
Comparative Efficacy and Safety of Anticoagulant, Combination, and Antiplatelet Therapies in Patients with Intracardiac Thrombus: A Real-World Retrospective Study
Chenxiao Jiang 1,2
Xinyu Wang 1
Baoyan Wang 2
Xin Chen 3
Biao Xu 3
Jie Ni 1,4
Dujuan Sha 1,4
1. Department of General Medicine, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Nanjing, Jiangsu 210008, China, Nanjing, China
2. Department of Pharmacy, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu 210008, China, Nanjing, China
3. Department of Cardiology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu 210008, China, Nanjing, China
4. Department of General Medicine, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu 210008, China, Nanjing, China
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Abstract
Background: Intracardiac thrombus is associated with significant morbidity and mortality; however, optimal antithrombotic strategies remain uncertain. Objectives: To evaluate the efficacy and safety of different antithrombotic regimens in patients with intracardiac thrombus. Methods: In this retrospective study, patients with intracardiac thrombus were enrolled at Nanjing Drum Tower Hospital. Logistic regression assessed the association between antithrombotic therapies and thrombus dissolution, while Cox regression evaluated the association with all-cause mortality. Thromboembolic events and clinically related major bleeding (CRMB) events were compared across treatment groups using chi-square or Fisher's exact tests. Kaplan-Meier curves depicted one-year cumulative incidence, with subgroup analyses presented using forest plots. Results: A total of 214 patients were included, of whom 26 received antiplatelet therapy, 118 anticoagulant therapy, and 70 combination therapy. Compared with antiplatelet therapy, anticoagulant therapy was associated with a significantly higher likelihood of thrombus dissolution in the Model 1 (aOR 3.56, 95% CI 1.16-11.20), although this association was attenyated in Model 2 (aOR 2.52, 95% CI: 0.72-9.01). Combination therapy showed a non-significant trend toward improved thrombus dissolution in both Models 1 (aOR 2.40, 95% CI 0.77-7.37) and Model 2 (aOR 2.12, 95% CI 0.66-6.66) . For all-cause mortality, anticoagulant therapy was consistently associated with a significantly lower risk compared with antiplatelet therapy in both adjusted models (Model 1: aHR 0.20, 95% CI 0.05-0.79; Model 2: aHR 0.16, 95% CI 0.03-0.78). Compared with antiplatelet therapy, combination therapy was associated with reduced all-cause mortality in the Model 1 (aHR 0.16, 95% CI 0.03-0.90) but not Model 2 (aHR 0.34, 95% CI 0.06-1.75). Combination therapy showed a non-significant trend toward improved thrombus dissolution or all-cause mortality compared with anticoagulant therapy. Conclusions: In patients with intracardiac thrombus, anticoagulant monotherapy was associated with a significantly lower one-year all-cause mortality compared with antiplatelet therapy, whereas its effect on thrombus dissolution was attenuated after full adjustment, potentially reflecting thrombus-related heterogeneity. Combination therapy did not confer additional efficacy or safety benefits over antiplatelet or anticoagulant monotherapy.
Summary
Keywords
Anticoagulant therapy, antiplatelet therapy, combination therapy, efficacy, Intracardiac thrombus, Safety
Received
13 October 2025
Accepted
05 February 2026
Copyright
© 2026 Jiang, Wang, Wang, Chen, Xu, Ni and Sha. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Dujuan Sha
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