Key result
Novel oral anticoagulants significantly increased the thrombolysis rate compared to vitamin K antagonists (78.0% vs. 63.5%, OR 2.32) in patients with nonvalvular atrial fibrillation and atrial thrombus.
Why the study?
To compare the efficacy and safety of novel oral anticoagulants and vitamin K antagonists in nonvalvular atrial fibrillation patients with left atrial/left atrial thrombosis.
Do novel oral anticoagulants (NOACs) improve thrombolysis rate compared to vitamin K antagonists in patients with nonvalvular atrial fibrillation and left atrial/left atrial appendage thrombosis?
Meta-Analysis (n=982)
Do novel oral anticoagulants (NOACs) improve thrombolysis rate compared to vitamin K antagonists in patients with nonvalvular atrial fibrillation and left atrial/left atrial appendage thrombosis?
Effect estimate: OR 2.32 (95% CI 1.71 to 3.15)
Absolute Event Rate: 78% vs 63.5%
p-value: p=<0.0001
In patients with nonvalvular atrial fibrillation and left atrial thrombus, NOACs are associated with a significantly higher rate of thrombus resolution compared to VKAs, with no difference in adverse events.
Supports NOAC preference over VKAs for left atrial thrombus resolution in NVAF; strengthens pooled evidence without added adverse events.
Background: To compare the efficacy and safety of novel oral anticoagulants (NOACs) and vitamin K antagonists (VKAs) in nonvalvular atrial fibrillation (NVAF) patients with left atrial/left atrial thrombosis through a systematic review and meta-analysis. Methods: The CBM (China Biology Medicine disc), CNKI (China National Knowledge Infrastructure), VIP (Chinese Technology Periodical Database), Wanfang, PubMed, Embase, Cochrane Library, and Web of Science databases were searched for relevant studies from their inception to June 30, 2022. Results: Twelve articles (eight cohort studies and four randomized controlled trials) involving 982 patients were included. Meta-analysis showed that NOACs had a significantly higher thrombolysis rate than VKAs (78.0% vs. 63.5%, odds ratio (OR) = 2.32, 95% confidence interval (CI) 1.71 to 3.15, p < 0.0001). Subgroup analysis revealed rivaroxaban to be more effective than VKAs, whereas there was no significant difference between dabigatran and apixaban. There were no significant differences in embolic events, bleeding, or all-cause mortality. Thrombus resolution analysis showed higher left ventricular end-diastolic diameter and smaller left atrial diameter in the effective group than in the ineffective group. Conclusions: NOACs are more effective in thrombolysis than VKAs in NVAF patients with left atrial thrombosis, and there is no increased risk of adverse events compared with VKAs.
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Mo et al. (2025) conducted a meta-analysis in Nonvalvular atrial fibrillation with left atrial/left atrial appendage thrombus (n=982). Novel oral anticoagulants (NOACs) vs. Vitamin K antagonists (VKAs) was evaluated on Thrombolysis rate (OR 2.32, 95% CI 1.71 to 3.15, p=<0.0001). Novel oral anticoagulants significantly increased the thrombolysis rate compared to vitamin K antagonists (78.0% vs. 63.5%, OR 2.32) in patients with nonvalvular atrial fibrillation and atrial thrombus.
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