What question did this study set out to answer?

To assess the frequency of use, efficacy, and safety of direct oral anticoagulants (DOACs) in the treatment of left ventricular thrombus (LVT).

February 9, 2019American Journal of Therapeutics

Use of Direct Oral Anticoagulants in the Treatment of Left Ventricular Thrombus: Systematic Review of Current Literature

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Why the study?

DOACs are increasingly used to treat left ventricular thrombus despite a lack of randomized trials or knowledge regarding their efficacy.

Do direct oral anticoagulants (DOACs) improve thrombus resolution in patients with left ventricular thrombus?

Comparison

DOAC treatment (rivaroxaban, apixaban, or dabigatran)

Design

Systematic review

Authors

MKMarvin KajySpectrum Health MSMohamed ShokrNational Authority for Remote Sensing and Space Sciences PRPreeti RamappaJohn D. Dingell VA Medical Center

Discussion

Member takes

Implication

Supports DOAC use for left ventricular thrombus; extends evidence as alternative to vitamin K antagonists while warranting randomized trials.

Key Points

To assess the frequency of use, efficacy, and safety of direct oral anticoagulants (DOACs) in the treatment of left ventricular thrombus (LVT).
Systematic search of Google Scholar, PubMed, MEDLINE, and Embase from DOAC introduction through April 2018.
Identified and analyzed 30 published articles comprising 41 patients diagnosed with LVT and treated with a DOAC.
Evaluated primary endpoints of thrombus resolution and time to resolution, alongside bleeding and thromboembolic events.
Patients received rivaroxaban (51.2%), apixaban (26.8%), or dabigatran (22.0%), administered alone (46.3%), with aspirin (12.2%), with clopidogrel (2.4%), or as triple therapy (39.0%).
Thrombus resolution rates were 81.0% for rivaroxaban, 100% for apixaban, and 88.9% for dabigatran, with median resolution times of 40, 36, and 24 days, respectively.
Adverse outcomes during DOAC therapy included one nonfatal bleeding event and one stroke event across the cohort.

Structured PICO

Do direct oral anticoagulants (DOACs) improve thrombus resolution in patients with left ventricular thrombus?

Population

41 patients with left ventricular thrombus (LVT) described across 30 articles

Intervention

Direct oral anticoagulants (DOACs: rivaroxaban, apixaban, or dabigatran) administered alone (46.3%), with aspirin (12.2%), with clopidogrel (2.4%), or as triple therapy (39%)

Outcome

Thrombus resolution and time to resolutionsurrogate

DOACs appear to be a reasonable and effective alternative to vitamin-K antagonists for the treatment of left ventricular thrombus, demonstrating high rates of thrombus resolution.

Cite This Study

Kajy et al. (2019) studied this question.

synapsesocial.com/papers/6a7e037330df0be8fb5ca34f https://doi.org/10.1097/mjt.0000000000000937

Topics

Anticoagulation in AF

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Implication

Supports DOAC use for left ventricular thrombus; extends evidence as alternative to vitamin K antagonists while warranting randomized trials.

Use of Direct Oral Anticoagulants in the Treatment of Left Ventricular Thrombus: Systematic Review of Current Literature

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Topics

Use of Direct Oral Anticoagulants in the Treatment of Left Ventricular Thrombus: Systematic Review of Current Literature

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Also Consider

Topics

Also Consider