Left ventricular (LV) thrombus formation complicates 15% of acute myocardial infarctions (MIs), and it is even more common in conditions of impaired LV systolic function. [1][2][3] If left untreated, up to 20% of patients can have significant complications, including stroke and systemic embolism. 3 Current consensus guidelines recommend the use of vitamin K antagonists (VKAs) to treat LV thrombi following acute MIs for 3-6 months. 4,5 Direct oral anticoagulants (DOACs) are a preferred alternative to VKAs, as they have lower bleeding rates, fewer drug interactions, rapid onset of action, and decreased need for monitoring. 6 However, the use of DOACs for this indication remains off-label. Many observational studies have shown comparable safety and efficacy of DOACs to VKAs in the management of LV thrombi. [7][8][9] However, a recent large cohort study identified a higher risk of stroke or systemic embolism with DOACs, calling into question their use in the treatment of LV thrombi. 10 The aim of this systematic review and meta-analysis was to compare the safety and efficacy of DOACs to VKAs in the ABSTRACT Background: There is increasing interest in direct oral anticoagulants (DOACs), given their safety and convenience in atrial fibrillation, compared with vitamin K antagonists (VKAs). However, the use of DOACs in left ventricular (LV) thrombi is considered off-label, with current guidelines recommending VKAs. The aim of this meta-analysis was to compare the safety and efficacy of DOACs to VKAs in the management of LV thrombi. Methods: A systematic search was conducted for studies published between January 1, 2009 and January 31, 2021 in PubMed, Embase, and CENTRAL. Included studies compared DOACs to VKAs for the treatment of LV thrombi and reported on relevant outcomes. Odds ratios (ORs) were pooled with a random-effects model. Results: Sixteen cohort studies and 2 randomized controlled trials were identified, which included 2666 patients (DOAC = 674; VKA = 1992). Compared with VKAs, DOACs were associated with a statistically significant reduction in stroke (OR 0.63, 95% confidence interval [CI] 0.42-0.96; P = 0.03; I 2 = 0%). There were no significant differences in bleeding (OR 0.72, 95% CI 0.50-1.02; P = 0.07; I 2 = 0%), systemic embolism (OR 0.77, 95% CI 0.41-1.44; P = 0.41; I 2 = 0%), stroke or systemic embolism (OR 0.83, 95% CI 0.53-1.33; P = 0.45; I 2 = 33%), mortality (OR 1.01, 95% CI 0.64-1.57; P = 0.98; I 2 = 0%) or LV thrombus resolution (OR 1.29, 95% CI 0.83-1.99; P = 0.26; I 2 = 56%).

IntroductionThe period following hospitalisation for chronic obstructive pulmonary disease (COPD) or heart failure (HF)—when patients transition between settings and clinicians—is one of high risk. Transitional care services that bridge the gap from hospital to home can improve outcomes, but there are no widely accepted indicators to assess their quality.Methods and analysisIn this systematic review, we will summarise transitional care quality indicators, and describe their associations with clinical, patient-reported and cost outcomes. We will search MEDLINE, Embase, CINAHL and HealthSTAR, as well as grey literature and reference lists of included articles. We will screen all studies published between January 1990 and October 2019 that test an intervention that aims to improve the hospital-to-home transition for patients with COPD and/or HF; and measure at least one process (eg, medication errors), clinical (eg, hospital readmissions) or patient-reported (eg, health-related quality of life) outcome which will serve as a transitional care quality indicator . We will include randomised controlled trials, cohort studies, cross-sectional studies, interrupted time series studies and before–after studies. We will extract data in duplicate and classify transitional care quality indicators as structural, process-related or outcome-related. When possible, we will assess associations between transitional care quality indicators and clinical outcomes. In anticipation of conceptual and statistical heterogeneity, we will provide a qualitative synthesis and narrative review of the results.Ethics and disseminationThis review will provide a list of transitional care quality indicators and their associations with clinical outcomes. These results can be used by hospitals, administrators and clinicians for assessing the quality of transitional care provided to patients with COPD and HF. The findings can also be used by policy-makers to assess and incentivise transitional care quality. We will disseminate results through publications, social media releases and presentations.PROSPERO registration numberThis study is registered on PROSPERO.

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AimsThere are no accepted quality indicators for transitional care in heart failure (HF). Current quality measures focus on 30‐day readmissions without accounting for the competing risk of death or health outcomes. In this scoping review of clinical trials, we aimed to develop a set of transitional care quality indicators in patients hospitalized for HF.Methods and ResultsWe performed a scoping review using MEDLINE, Embase, CINAHL, HealthSTAR, reference lists and grey literature from January 1990 to November 2022. We included randomized controlled trials (RCTs) of adults hospitalized for HF who received a healthcare service or care strategy intervention that aimed to improve patient‐reported or clinical outcomes. We independently extracted data and performed a qualitative synthesis of the results. We generated a list of process, structure, patient‐reported, and clinical outcomes that could be used as quality indicators based on their fulfillment of COnsensus‐based Standards for the selection of health Measurement Instruments (COSMIN) and United States Federal Drug Administration (FDA) standards. We included 42 RCTs and identified ten process, six structure, two patient‐reported, and four clinical indicators. Three process indicators were associated with clinically relevant outcomes.ConclusionIn this scoping review, we developed a list of quality indicators to guide future efforts in measuring and improving transitional care in HF. Clinicians, researchers, institutions, and policymakers can use the indicators to guide management, design research, allocate resources, and fund services that improve clinical outcomes.This article is protected by copyright. All rights reserved.