Direct oral anticoagulants showed no significant difference in stroke or systemic embolism compared to vitamin K antagonists in patients with left ventricular thrombus (OR 0.81; 95% CI 0.57-1.15).
Meta-Analysis (n=3,587)
Do direct oral anticoagulants (DOACs) reduce stroke or systemic embolism compared to vitamin K antagonists (VKAs) in patients with left ventricular thrombus?
In patients with left ventricular thrombus, DOACs appear to have similar efficacy to VKAs for stroke prevention and thrombus resolution, but may offer a mortality and safety benefit with fewer bleeding events.
Odds Ratio: 0.81 (95% CI 0.57–1.15)
AIMS: Direct oral anticoagulants (DOACs) are increasingly used off-label to treat patients with left ventricular thrombus (LVT). We analysed available meta-data comparing DOACs and vitamin K antagonists (VKAs) for efficacy and safety. METHODS: We conducted a systematic search and meta-analysis of observational and randomized data comparing DOACs vs. VKAs in patients with LVT. Endpoints of interest were stroke or systemic embolism, thrombus resolution, all-cause death, and a composite bleeding endpoint. Estimates were pooled using a random-effects model meta-analysis, and their robustness was investigated using sensitivity and influential analyses. RESULTS: We identified 22 articles (18 observational studies, 4 small randomized clinical trials) reporting on a total of 3587 patients (2489 VKA vs. 1098 DOAC therapy). The pooled estimates for stroke or systemic embolism odds ratio (OR): 0.81; 95% confidence interval (CI): 0.57, 1.15 and thrombus resolution (OR: 1.12; 95% CI: 0.86, 1.46) were comparable, and there was low heterogeneity overall across the included studies. The use of DOACs was associated with lower odds of all-cause death (OR: 0.65; 95% CI: 0.46, 0.92) and a composite bleeding endpoint (OR: 0.67; 95% CI: 0.47, 0.97). A risk of bias was evident particularly for observational reports, with some publication bias suggested in funnel plots. CONCLUSION: In this comprehensive analysis of mainly observational data, the use of DOACs was not associated with a significant difference in stroke or systemic embolism, or thrombus resolution, compared with VKA therapy. The use of DOACs was associated with a lower rate of all-cause death and fewer bleeding events. Adequately sized randomized clinical trials are needed to confirm these findings, which could allow a wider adoption of DOACs in patients with LVT.
Haller et al. (Thu,) conducted a meta-analysis in Left ventricular thrombus (n=3,587). Direct oral anticoagulants (DOACs) vs. Vitamin K antagonists (VKAs) was evaluated on Stroke or systemic embolism (OR 0.81, 95% CI 0.57-1.15). Direct oral anticoagulants showed no significant difference in stroke or systemic embolism compared to vitamin K antagonists in patients with left ventricular thrombus (OR 0.81; 95% CI 0.57-1.15).
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