Direct oral anticoagulants vs. vitamin K antagonists for the treatment of left ventricular thrombosis: a systematic review of the literature and meta-analysis

Left ventricular thrombus (LVT) is a frightening complication primarily occurring in patients with LV dysfunction following a large myocardial infarction (MI). Left ventricular thrombus is associated with an increased risk of stroke, systemic embolism, and subsequent morbidity and mortality.1 Reperfusion strategies led to a dramatical reduction of its incidence, with estimates now ranging from 1 to 26% according to the MI location and the diagnostic imaging technique used.1 International guidelines recommend anticoagulation for at least 3 months, according to thrombus resolution and individualized bleeding risk, with vitamin K antagonists (VKA) as the first-line therapy.2 Direct oral anticoagulants (DOACs) have been approved for use in non-valvular atrial fibrillation, venous thromboembolism, and other hypercoagulable conditions.3 Due to their oral bioavailability, predictable pharmacokinetics and safety profile, nowadays are the preferred treatment option for most of the eligible patients,3 with an off-label extension to the ones with LVT. However,...