Key result
DOACs significantly reduced the risk of bleeding events (RR 0.73, P=0.004) and stroke (RR 0.72, P=0.03) compared with vitamin K antagonists in patients with left ventricular thrombus.
Why the study?
Vitamin K antagonists used to treat left ventricular thrombus have several known risks, leading to increased DOAC use, but their comparative safety and efficacy needed evaluation.
Do DOACs reduce bleeding events and stroke compared to VKAs in patients with left ventricular thrombus?
Meta-Analysis (n=3,172)
Yes
Do DOACs reduce bleeding events and stroke compared to VKAs in patients with left ventricular thrombus?
Relative Risk: 0.73
p-value: p=0.004
DOACs appear to be a safe and effective alternative to VKAs for the treatment of left ventricular thrombus, significantly reducing the risk of bleeding and stroke.
DOACs associated with lower bleeding and stroke risk than VKAs for LVT; leaves open need for dedicated RCTs before practice change.
AIMS: Left ventricular thrombus (LVT) increases the risk of thrombotic events and mortality. Vitamin K antagonists (VKAs) used to treat LVT have several known risks, as a result of which direct oral anticoagulant (DOAC) use has recently increased. We aimed to evaluate the safety and efficacy of DOACs and VKAs in treating LVT. METHODS AND RESULTS: We searched PubMed, Embase, Cochrane Library trials, and Web of Science databases for studies published before 19 April 2022, involving DOAC versus VKA treatment for patients with LVT. This meta-analysis comprised 21 studies (total patients, n = 3172; DOAC group, n = 888; VKA group, n = 2284). A statistically significant reduction in bleeding events was observed in patients on DOACs vs. those on VKAs (risk ratio (RR) = 0.73, P = 0.004). Patients on DOACs residing in North American and European regions and those with ischaemic heart disease (IHD) had a significantly lower risk of bleeding events than patients residing in other regions or those with a different LVT aetiology, respectively (RR = 0.78, P = 0.04; RR = 0.38, P = 0.02; and RR = 0.63, P = 0.009). A statistically significant reduction in stroke in patients on DOACs versus VKAs (RR = 0.72, P = 0.03) was observed, and patients on DOACs residing in North America and those with IHD had a significantly lower risk of stroke (RR = 0.73, P = 0.04, and RR = 0.61, P = 0.03, respectively). Compared with VKAs, DOACs are statistically associated with an increase in LVT resolution at 1 month (RR = 1.96, P = 0.008). No statistical between-group difference in all-cause mortality (RR = 0.72, P = 0.05), systemic embolism (RR = 0.87, P = 0.74), stroke or systemic embolism (RR = 0.90, P = 0.50), and LVT resolution at the end of follow-up (RR = 1.06, P = 0.13) was observed. CONCLUSIONS: Compared with VKAs, DOACs significantly reduce the risk of bleeding events and stroke in LVT patients, but mortality was similar in both groups. The advantages are apparent not only in patients belonging to the predominantly white residential areas such as North American and European regions but also in patients with LVT due to IHD. DOACs show promising effects in treating LVT compared with VKAs.
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Huang et al. (2022) conducted a meta-analysis in Left ventricular thrombus (LVT) (n=3,172). Direct oral anticoagulants (DOACs) vs. Vitamin K antagonists (VKAs) was evaluated on Bleeding events (RR 0.73, p=0.004). DOACs significantly reduced the risk of bleeding events (RR 0.73, P=0.004) and stroke (RR 0.72, P=0.03) compared with vitamin K antagonists in patients with left ventricular thrombus.
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