Key result
Direct oral anticoagulants showed no significant difference in stroke or systemic embolism (OR 0.89) but significantly reduced bleeding events (OR 0.61) compared to vitamin K antagonists in patients with left ventricular thrombus.
Why the study?
Studies comparing direct oral anticoagulants to vitamin K antagonists for left ventricular thrombus anticoagulation are small-scale and have yielded conflicting results.
Do direct oral anticoagulants (DOACs) reduce stroke or systemic embolism and bleeding compared to vitamin K antagonists in patients with left ventricular thrombus?
Meta-Analysis (n=1,892)
Do direct oral anticoagulants (DOACs) reduce stroke or systemic embolism and bleeding compared to vitamin K antagonists in patients with left ventricular thrombus?
Odds Ratio: 0.89 (95% CI 0.46–1.71)
p-value: p=0.73
DOACs appear to be a feasible alternative to VKAs for left ventricular thrombus, offering similar efficacy for stroke prevention and thrombus resolution but with a significantly lower risk of bleeding.
May support DOAC consideration as VKA alternative in LVT with similar efficacy and less bleeding; leaves open need for RCTs before changing practice.
Current American College of Cardiology/American Heart Association guidelines for stroke or ST-elevation myocardial infarction recommend the use of oral vitamin K antagonists (VKAs) as a first-line anticoagulant. Although several studies have compared the use of direct oral anticoagulants (DOACs) to VKAs for left ventricular thrombus (LVT) anticoagulation therapy, they are small scale and have produced conflicting results. Thus, this meta-analysis was performed to aggregate these studies to better compare the efficacy and safety of DOACs with VKAs in patients with LVT. Cochrane Library, Google Scholar, MEDLINE, and Web of Science database searches through January 10, 2021 were performed. Eight studies evaluating stroke or systemic embolism (SSE), six studies for LVT resolution, and five studies for bleeding were included. There were no statistically significant differences in SSE (OR 0.89; 95% CI 0.46, 1.71; p = 0.73; I2 = 45%) and LVT resolution (OR 1.13; 95% CI 0.75, 1.71; p = 0.56; I2 = 1%) between DOAC and VKA (reference group) therapy. DOAC use was significantly associated with lower bleeding event rates compared to VKA use (OR 0.61; 95% CI 0.40, 0.93; p = 0.02; I2 = 0%). DOACs may be feasible alternative anticoagulants to vitamin K antagonists for LV thrombus treatment. Randomized controlled trials directly comparing DOACs with VKAs are needed.
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Kido et al. (2021) conducted a meta-analysis in Left ventricular thrombus (n=1,892). Direct oral anticoagulants vs. Vitamin K antagonists was evaluated on Stroke or systemic embolism (SSE) (OR 0.89, 95% CI 0.46, 1.71, p=0.73). Direct oral anticoagulants showed no significant difference in stroke or systemic embolism (OR 0.89) but significantly reduced bleeding events (OR 0.61) compared to vitamin K antagonists in patients with left ventricular thrombus.
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