Key result
Novel oral anticoagulants showed similar efficacy in preventing stroke or systemic embolism compared to vitamin K antagonists, but significantly reduced the risk of stroke (RR 0.68) and clinically relevant bleedings (RR 0.35).
Why the study?
Although VKAs are first-line anticoagulants for patients with left ventricular thrombus, accumulating evidence suggests NOACs could be safe alternatives, requiring evaluation of their efficacy and safety.
Do NOACs improve efficacy and safety outcomes in patients with left ventricular thrombus compared to VKAs?
Meta-Analysis (n=2,467)
Do NOACs improve efficacy and safety outcomes in patients with left ventricular thrombus compared to VKAs?
Effect estimate: RR 0.96 (95% CI 0.80-1.16)
p-value: p=0.68
NOACs appear to be a safe and effective alternative to VKAs for patients with left ventricular thrombus, demonstrating similar overall efficacy with potentially lower risks of stroke and clinically relevant bleeding.
NOACs may be considered for left ventricular thrombus; hypothesis-generating until confirmed in randomized trials.
Background Although vitamin K antagonists (VKAs) are recommended as first-line anticoagulants for patients with left ventricular thrombus (LVT), accumulating evidence suggests novel oral anticoagulants (NOACs) could be safe alternatives for VKAs. Efficacy and safety of NOACs should be assessed to justify their usage for LVT patients. Design We performed a meta-analysis of observational studies to evaluate the efficacy and safety of NOACs as compared to VKAs in LVT patients. Methods PubMed and EMBASE databases were searched for articles published until November 12, 2020. Two reviewers independently extracted relevant information from articles and assessed the study quality. Pooled effects were estimated using Mantel–Haenssel 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, NOACs 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 = 0.20), but significantly reduced the risk of stroke (RR: 0.68, 95% CI: 0.47-1.00, P < 0.05). For safety outcomes, NOACs 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 VKAs users. Conclusions Compared with VKAs, NOACs 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. (2020) conducted a meta-analysis in Left Ventricular Thrombus (LVT) (n=2,467). Novel Oral Anticoagulants (NOACs) vs. Vitamin K Antagonists (VKAs) was evaluated on Stroke or systemic embolism (SSE) (RR 0.96, 95% CI 0.80-1.16, p=0.68). Novel oral anticoagulants showed similar efficacy in preventing stroke or systemic embolism compared to vitamin K antagonists, but significantly reduced the risk of stroke (RR 0.68) and clinically relevant bleedings (RR 0.35).
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