Key result
Direct oral anticoagulants reduced any adverse event (composite of thromboembolism or bleeding) compared to vitamin K antagonists (4.2% vs 22.9%; log OR -1.93, 95% CI -3.33 to -0.75).
Why the study?
Conventional treatment with VKAs for LV thrombus carries bleeding risks, and while DOACs appear promising, randomized trial data have been scant.
Do direct oral anticoagulants (DOACs) reduce thromboembolic and bleeding events compared to vitamin K antagonists (VKAs) in patients with left ventricular thrombus?
Meta-Analysis (n=141)
Do direct oral anticoagulants (DOACs) reduce thromboembolic and bleeding events compared to vitamin K antagonists (VKAs) in patients with left ventricular thrombus?
Effect estimate: log OR -1.93 (95% CI -3.33 to -0.75)
Absolute Event Rate: 4.2% vs 22.9%
In patients with LV thrombus, pooled RCT data suggests DOACs are associated with fewer thromboembolic and bleeding events compared to VKAs, with similar rates of thrombus resolution.
May favor DOACs over VKAs to reduce adverse events in LV thrombus; extends sparse RCT data but low-certainty evidence requires larger trials.
Patients with impaired left ventricular (LV) function can develop LV thrombus, a potentially life‐threatening condition due to risk of stroke and embolization. Conventional treatment with vitamin K antagonists (VKAs; e.g., warfarin) puts patients at risk of bleeding, and the use of direct oral anticoagulants (DOACs) appears promising, although data are scant. We searched the published English language literature for randomized controlled trials (RCTs) comparing DOACs with VKAs in LV thrombus. End points were failure to resolve, thromboembolic events (stroke, embolism), bleeding, or any adverse event (composite of thromboembolism or bleeding), or all‐cause death. Data were pooled and analyzed in hierarchical Bayesian models. In three eligible RCTs, 141 patients were studied during an average of 4.6 months (53.8 patient‐years; n = 71 assigned to DOAC, n = 70 assigned to VKA). A similar number of patients in each treatment arm demonstrated failure to resolve (DOAC: 14/71 vs. VKA: 15/70) and death events (3/71 vs. 4/70). However, patients on DOACs suffered fewer strokes/thromboembolic events (1/71 vs. 7/70; log odds ratio [OR], −2.02 [95% credible interval (CI 95 ), −4.53 to −0.31]) and fewer bleeding events (2/71 vs. 9/70; log OR, −1.62 [CI 95 , −3.43 to −0.26]), leading to fewer patients on DOACs with any adverse event versus VKAs (3/71 vs. 16/70; log OR, −1.93 [CI 95 , −3.33 to −0.75]). In conclusion, pooled analysis of RCT data favors DOACs over VKAs in patients with LV thrombus in terms of both efficacy and safety.
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Sahlén et al. (2023) conducted a meta-analysis in Left ventricular thrombus (n=141). Direct oral anticoagulants (DOACs) vs. Vitamin K antagonists (VKAs) was evaluated on Any adverse event (composite of thromboembolism or bleeding) (log OR -1.93, 95% CI -3.33 to -0.75). Direct oral anticoagulants reduced any adverse event (composite of thromboembolism or bleeding) compared to vitamin K antagonists (4.2% vs 22.9%; log OR -1.93, 95% CI -3.33 to -0.75).
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