Key result
Direct oral anticoagulants for left ventricular thrombus showed better thrombus resolution than vitamin K antagonists (72.59% vs 67.49%; OR 1.28, 95% CI 1.07-1.53) and reduced bleeding and stroke.
Why the study?
Current clinical guidelines for treating left ventricular thrombus are limited by inadequate evidence to inform the comparative efficacy of oral anticoagulants.
Does DOAC improve thrombus resolution and reduce adverse clinical events compared to VKA in patients with left ventricular thrombus?
Meta-Analysis
Does DOAC improve thrombus resolution and reduce adverse clinical events compared to VKA in patients with left ventricular thrombus?
Answers are grounded in this paper and cite their sources.
DOACs appear to be a safer and more effective alternative to VKAs for the treatment of left ventricular thrombus, offering higher rates of thrombus resolution and lower risks of stroke and bleeding.
Background and Aims: Current clinical guidelines for treating left ventricular thrombus (LVT) are limited by inadequate evidence to inform the comparative efficacy of oral anticoagulants. In this meta-analysis, we aimed to compare the efficacy and safety of direct oral anticoagulants (DOAC) to vitamin K antagonists (VKA) in patients with LVT. Methods: Four standard databases were searched for relevant literature comparing the efficacy and safety between DOAC and VKA for LVT treatment, published before August 19, 2023. Both the randomized controlled trials and observational studies were included in the analysis. The outcomes of interest were the resolution of LVT, all-cause mortality, stroke, systemic embolism, and bleeding. Data from the selected studies were extracted and analyzed using RevMan 5.4 using odds ratio. Results: Among 3959 studies from the database search and bibliography review, 33 were included in the analysis. LVT resolution was observed in 72.59% in the DOAC group versus 67.49% in the VKA group (odds ratio [OR]: 1.28, confidence interval [CI]: 1.07-1.53). Mortality was lower in the DOAC group (11.71% vs. 18.56%) (OR: 0.60, CI: 0.36-1.00; borderline statistical significance). Likewise, bleeding events (9.60% vs. 13.19%) (OR: 0.65, CI: 0.52-0.81) and stroke (7.54% vs. 11.04%) (OR: 0.71, CI: 0.53-0.96) were also significantly lower in the DOAC group. Conclusion: DOAC use for LVT showed better thrombus resolution and reduced risk of bleeding and stroke compared to VKA. Likewise, DOAC use was associated with lower mortality with borderline statistical significance.
No takes yet. Share an insight, caveat, or question.
Shrestha et al. (2023) conducted a meta-analysis in Left ventricular thrombus. Direct oral anticoagulants (DOAC) vs. Vitamin K antagonists (VKA) was evaluated on Resolution of LVT (OR 1.28, 95% CI 1.07-1.53). Direct oral anticoagulants for left ventricular thrombus showed better thrombus resolution than vitamin K antagonists (72.59% vs 67.49%; OR 1.28, 95% CI 1.07-1.53) and reduced bleeding and stroke.
Synapse has enriched 10 related papers. Consider them for comparative context: