Key result
NOACs show similar risk of left atrial thrombi compared to VKAs in AF.
Why the study?
Anticoagulant effects and side effects of NOACs compared to VKAs in patients with atrial fibrillation remain a focus of research, particularly regarding left atrial thrombi incidence.
Do NOACs reduce the incidence of left atrial thrombi on transesophageal echocardiography compared to VKAs in patients with atrial fibrillation?
Meta-Analysis (n=7,016)
Do NOACs reduce the incidence of left atrial thrombi on transesophageal echocardiography compared to VKAs in patients with atrial fibrillation?
Odds Ratio: 0.74 (95% CI 0.55–1)
NOACs may be associated with a lower incidence of left atrial thrombi on transesophageal echocardiography compared to VKAs in patients with atrial fibrillation, with no significant differences among specific NOAC agents.
NOACs reduce major bleeding versus VKAs with similar thromboembolic risk during AF ablation; reinforces guideline preference for NOACs.
BACKGROUND: High risk of embolic events exists in both patients with chronic atrial fibrillation (AF) and patients in the perioperative period of ablation (effective treatment for AF). Therefore, anticoagulant therapy is important. Oral anticoagulants can be divided into two major categories: vitamin K antagonists (VKAs) and non-vitamin K antagonist oral anticoagulants (NOACs). VKAs, represented by warfarin, have been widely used as traditional anticoagulants, whereas NOACs have been used in clinical practice, but their anticoagulant effects and side effects are still the focus of research. We used a meta-analysis to compare the incidence of left atrial thrombi (LAT) between different anticoagulants. METHODS: We searched PubMed, EMBASE, Web of Science, and the Cochrane Library databases for observational studies that compared the transesophageal echocardiography (TEE) findings for patients treated with NOACs and VKAs. The incidence of LAT and dense spontaneous echocardiographic contrast (dense SEC) were extracted as the basis of the meta-analysis. RESULTS: Fifteen studies were included in the meta-analysis. We found that patients anticoagulated with NOACs and VKAs had similar incidence of LAT (OR = 0.74, 95%CI: 0.55-1.00). After excluding the heterogeneous article by sensitivity analysis, we found the incidence of LAT in patients anticoagulated with NOACs is lower than VKAs (OR = 0.59, 95%CI: 0.42-0.84). The results of subgroup analysis showed that the incidence of LAT among three types of NOACs have no significant difference (dabigatran vs. rivaroxaban, OR = 1.16 [0.75, 1.81]; rivaroxaban vs. apixaban, OR = 0.97 [0.54, 1.74]; dabigatran vs. apixaban, OR = 1.09 [0.55, 2.16]). CONCLUSION: Patients anticoagulated with NOACs may have lower incidence of LAT than VKAs. The incidence of LAT among different type of NOACs are similar.
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Yang et al. (2019) conducted a meta-analysis in Atrial fibrillation (n=7,016). Non-vitamin K antagonist oral anticoagulants (NOACs) vs. Vitamin K antagonists (VKAs) was evaluated on Incidence of left atrial thrombi (LAT) (OR 0.74, 95% CI 0.55-1.00). Non-vitamin K antagonist oral anticoagulants were associated with a similar incidence of left atrial thrombi compared to vitamin K antagonists in patients with atrial fibrillation (OR 0.74).