Key result
Direct oral anticoagulants were not inferior to vitamin K antagonists for systemic thromboembolism, LV thrombus resolution, and bleeding in patients with left ventricular thrombus.
Why the study?
VKAs are guideline-recommended to reduce systemic thromboembolic events in patients with LV thrombus, but data supporting DOAC use as an alternative are lacking.
Do direct oral anticoagulants (DOACs) prevent systemic thromboembolic events and improve thrombus resolution in patients with left ventricular thrombus compared to vitamin K antagonists?
Meta-Analysis
Do direct oral anticoagulants (DOACs) prevent systemic thromboembolic events and improve thrombus resolution in patients with left ventricular thrombus compared to vitamin K antagonists?
p-value: p== .808
DOACs appear to be a safe and effective alternative to VKAs for the treatment of left ventricular thrombus, with comparable rates of systemic thromboembolism, thrombus resolution, and bleeding.
DOACs may be viable alternatives to VKAs for LV thrombus; leaves open need for RCTs to confirm noninferiority.
BACKGROUND: Current guidelines recommend vitamin K antagonists (VKAs) to reduce the risk of systemic thromboembolic (STE) events in patients with left ventricular (LV) thrombus. Direct oral anticoagulants (DOACs) are an emerging alternative to VKAs; however, data supporting DOAC use in LV thrombus are still lacking. We conducted this systematic review and meta-analysis to compare the efficacy and safety between DOACs and VKAs in this population. METHODS: We searched MEDLINE, Embase, and the Cochrane Library databases from inception to October 2020 to identify studies that compared clinical outcomes of interest, including stroke or any STE, LV thrombus resolution, and bleeding, between patients who used DOACs and VKAs for LV thrombus. Data from each study were combined using the random-effects model. RESULTS: = .808). CONCLUSIONS: Our meta-analysis found no significant differences in rates of STE events, LV thrombus resolution, or bleeding events between the use of DOACs and VKAs in LV thrombus. Further randomised controlled trials are needed to confirm our findingsHighlightsThere is limited evidence comparing the use of direct oral anticoagulants (DOACs) to vitamin K antagonists (VKAs) in left ventricular (LV) thrombus.Our systematic review and meta-analysis showed that DOACs are not inferior to VKAs in the incidence of systemic thromboembolism (STE), the rate of LV thrombus resolution, and the risk of bleeding.Current evidence is based on observational studies only. Further randomised controlled trials are needed to confirm the findings.
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Trongtorsak et al. (2021) conducted a meta-analysis in Left ventricular thrombus. Direct oral anticoagulants (DOACs) vs. Vitamin K antagonists (VKAs) was evaluated on Systemic thromboembolism, LV thrombus resolution, and bleeding (p== .808). Direct oral anticoagulants were not inferior to vitamin K antagonists for systemic thromboembolism, LV thrombus resolution, and bleeding in patients with left ventricular thrombus.
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