Key result
Direct oral anticoagulants demonstrated comparable rates of left ventricular thrombus resolution (RR 1.00) and a lower incidence of all-cause mortality (RR 0.65) compared to vitamin K antagonists.
Why the study?
To consolidate clinical evidence from trials and observational studies evaluating the efficacy and safety of DOACs versus VKAs for treating left ventricular thrombus.
Do direct oral anticoagulants improve thrombus resolution and safety outcomes in patients with left ventricular thrombus compared to vitamin K antagonists?
Meta-Analysis (n=3,027)
Do direct oral anticoagulants improve thrombus resolution and safety outcomes in patients with left ventricular thrombus compared to vitamin K antagonists?
Relative Risk: 1 (95% CI 0.93–1.08)
Absolute Event Rate: 65.3% vs 63.3%
DOACs appear as effective as VKAs for treating left ventricular thrombus with comparable resolution rates and potentially lower all-cause mortality, supporting their use as an alternative therapy.
DOACs match VKAs for LVT resolution and safety with lower mortality; extends observational data but leaves open need for large RCTs.
Objectives: The objective of this updated meta-analysis is to consolidate high-quality peer-reviewed clinical evidence, including trials and observational studies, to evaluate the efficacy and safety of “direct oral anticoagulants (DOACs)” versus “vitamin K antagonists (VKAs)” for treating “left ventricular thrombus (LVT)”. Methodology: We included studies of either "observational" or "experimental" in nature reported original data for the head-to-head comparison of "DOACs" and "VKAs" for the treatment of LVT. The efficacy-related outcome of interest was "thrombus resolution" and safety-related outcomes of interest were; "mortality", "major bleeding", and "stroke". The “risk ratios (RRs)” for each outcome variable were calculated using the “Mantel-Haenszel method”. Results: The analysis included 19 studies comprised of 3,027 patients diagnosed with LVT. Among them, 881 received DOAC treatment, while 2,146 were treated with VKAs. DOACs showed comparable rates of LVT resolution (RR: 1.00 [0.93 – 1.08]), lower mortality incidence (RR: 0.65 [0.51 – 0.84]), similar stroke incidence (RR: 0.83 [0.61 – 1.14]), and similar major bleeding incidence (RR: 0.71 [0.50 – 1.00]) compared to VKAs. Conclusion: The meta-analysis indicates that DOACs are as effective as VKAs for treating LVT, showing comparable thrombus resolution rates, lower all-cause mortality, similar stroke risks, and clinically relevant bleeding across studies. However, these conclusions are limited by the lack of evidence from large-scale randomized studies and high-quality real-life clinical data.
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Chand et al. (2023) conducted a meta-analysis in Left ventricular thrombus (LVT) (n=3,027). Direct oral anticoagulants (DOACs) vs. Vitamin K antagonists (VKAs) was evaluated on Thrombus resolution (RR 1.00, 95% CI 0.93-1.08). Direct oral anticoagulants demonstrated comparable rates of left ventricular thrombus resolution (RR 1.00) and a lower incidence of all-cause mortality (RR 0.65) compared to vitamin K antagonists.
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