Key result
DOACs match VKAs for preventing stroke in LV thrombus while reducing clinically relevant bleeding.
Why the study?
Although vitamin K antagonists are first-line therapy for left ventricular thrombus, accumulating evidence suggests direct oral anticoagulants may be safe alternatives, requiring evaluation of their efficacy and safety.
Do direct oral anticoagulants (DOACs) reduce stroke or systemic embolism and bleeding compared to vitamin K antagonists in patients with left ventricular thrombus?
Meta-Analysis (n=2,467)
Do direct oral anticoagulants (DOACs) reduce stroke or systemic embolism and bleeding compared to vitamin K antagonists in patients with left ventricular thrombus?
Effect estimate: RR 0.96 (95% CI 0.80-1.16)
p-value: p=0.68
In patients with left ventricular thrombus, DOACs appear to be a safe and effective alternative to VKAs, offering similar protection against systemic embolism with potentially lower risks of stroke and clinically relevant bleeding.
DOACs may be considered over VKAs for left ventricular thrombus with lower stroke and bleeding risks; leaves open need for confirmatory randomized trials.
INTRODUCTION: Although vitamin K antagonists (VKAs) are recommended as first-line anticoagulants for patients with left ventricular thrombus (LVT), accumulating evidence suggests direct oral anticoagulants (DOACs) could be safe alternatives for VKAs. Efficacy and safety of DOACs should be assessed to justify their usage for LVT patients. OBJECTIVES: To compare the efficacy and safety of DOACs and VKAs for the treatment of LVT. PATIENTS AND METHODS: We performed a meta-analysis of observational studies to compare DOACs to VKAs in LVT patients. The PubMed and EMBASE databases were searched for articles published until November 12, 2020. Pooled effects were estimated using Mantel-Haenszel method and presented as risk ratios (RR) using fixed-effect model. Reporting followed the Meta-analyses of observational studies in epidemiology (MOOSE) guideline. RESULTS: A total of 2467 LVT patients from 13 studies were included. Compared with VKAs, DOACs showed similar efficacy in prevention of stroke or systemic embolism (RR: 0.96, 95% confidence interval [CI]: 0.80-1.16, P = 0.68) and thrombus resolution (RR: 0.88, 95% CI: 0.72-1.09, P = 0.26), but significantly lower risk of stroke (RR: 0.68, 95% CI: 0.47-1.00, P = 0.048). For safety outcomes, DOAC users showed similar risk of any bleedings (RR: 0.94, 95% CI: 0.67-1.31, P = 0.70), but lower risk of clinically relevant bleedings (RR: 0.35, 95% CI: 0.13-0.92, P = 0.03) compared with VKA users. CONCLUSIONS: Compared with VKAs, DOACs acquired similar efficacy and safety profile for patients with LVT, but could reduce the risk of strokes and clinically relevant bleedings.
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Chen et al. (2021) conducted a meta-analysis in Left ventricular thrombus (n=2,467). Direct oral anticoagulants vs. Vitamin K antagonists was evaluated on Stroke or systemic embolism (RR 0.96, 95% CI 0.80-1.16, p=0.68). Direct oral anticoagulants showed similar efficacy to vitamin K antagonists in preventing stroke or systemic embolism (RR 0.96) in patients with left ventricular thrombus, while significantly reducing the risk of stroke and clinically relevant bleedings.
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