Direct oral anticoagulants <i>vs.</i> vitamin K antagonists for left ventricular thrombus: a systematic review and meta-analysis

Trongtorsak, Angkawipa; Thangjui, Sittinun; Kewcharoen, Jakrin; Polpichai, Natchaya; Yodsuwan, Ratdanai; Kittipibul, Veraprapas; Friedman, Harvey; Estrada, Alfonso

doi:10.1080/00015385.2020.1858538

Cited by 12 publications

(14 citation statements)

References 40 publications

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“…Second, the short duration or small dosage of anticoagulation could produce low efficacy of anticoagulation, and some patients who were already on oral anticoagulation might have a poor adherence such as bad monitoring of INR or irregular treatment. Otherwise, while most studies mainly compared the efficacy and safety between NOACs and VKAs [12][13][14][15][16][17][18][19][20][21][22][23] (Table S6), our study firstly offered a new idea towards exploring APT in VT treatment. Our study showed that the rates of bleeding, embolism, and all-cause death were similar among the NOACs, VKAs, and APT groups within a 12 months' follow-up.…”

Section: Non-vitamin K Antagonist Oral Anticoagulants In Pa-mentioning

confidence: 99%

“…2017 European guidelines also recommended that STEMI patients with left VT should maintain anticoagulation therapy for up to 6 months under the guidance of repeated imaging (Class II a, level C evidence) [11]. Up to date, quite a few studies reported that NOACs had comparable safety and efficacy outcomes in the treatment of VT [12][13][14][15][16][17][18][19][20][21][22][23][24]. Michael et al (2021) conducted a metaanalysis to compare NOACs to VKAs for the treatment of left ventricular thrombus, including a total of 18 studies with 2666 patients, and their result showed that NOACs had less 37% risk of stroke than VKAs, while no significances were observed in thrombus resolution, systemic embolism, bleeding, or all-cause death events.…”

Section: Introductionmentioning

confidence: 99%

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Different Oral Antithrombotic Therapy for the Treatment of Ventricular Thrombus: An Observational Study from 2010 to 2019

Lang

Quan

Gong

et al. 2022

International Journal of Clinical Practice

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Aim of the Study. To evaluate the utilization of oral antithrombotic agents, non-vitamin K antagonist oral anticoagulants (NOACs), vitamin K antagonists (VKAs), or antiplatelet therapy (APT), in ventricular thrombus (VT) patients and to analyze factors for thrombus resolution and clinical outcomes. Methods. This retrospective observational study was conducted from 2010 to 2019 in National Center of Cardiovascular Diseases of China. We included patients with VT confirmed by imaging. The primary outcome was the rate of thrombus resolution. Hazard ratio (HR) was calculated with or without adjustment for covariates using Cox proportional hazards regression models. Results. 463 patients were included. 43.0% received VKAs, 16.6% received NOACs, and 40.4% received APT. Over a median of 468 days’ follow-up, NOACs group was more likely to have the thrombus resolved within 12 months’ follow-up than VKAs (HR 2.28, 95% CI 1.57 to 3.31) or APT (HR 2.92, 95% CI 1.97 to 4.33). After adjustment for baseline variables, the significance remained in the comparison of NOACs versus VKAs (HR 2.13, 95% CI 1.41 to 3.22) as well as NOACs versus APT (HR 2.55, 95% CI 1.53 to 4.27). No significant differences were identified in bleeding rate, thromboembolism rate, or all-cause death in 12 months’ follow-up. Conclusion. Our findings showed that patients who were male, diagnosed with MI with or without ventricular aneurysm, or diagnosed with coronary artery diseases medical history had a risk of thrombus unresolved. Patients with NOACs had a higher resolution and a similar safety profile comparing VKAs or APT, which persisted after adjusting for other factors. Large randomized controlled trials are required urgently. This trial is registered with NCT05006677.

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Section: Non-vitamin K Antagonist Oral Anticoagulants In Pa-mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Different Oral Antithrombotic Therapy for the Treatment of Ventricular Thrombus: An Observational Study from 2010 to 2019

Lang

Quan

Gong

et al. 2022

International Journal of Clinical Practice

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“…In recent years, the number of DOAC-related publications has increased dramatically, and articles reporting the efficacy and safety of DOACs in treatment of LVT are becoming increasingly common. To the best of our knowledge, six systematic reviews and meta-analyses comparing VKAs and DOACs for the treatment of LVT have been published in the last several years [17][18][19][20][21][22]. Table 2 summarizes characteristics and main findings of previous meta-analyses and our study.…”

Section: Previous Studiesmentioning

confidence: 98%

“…Recently, several meta-analysis articles have been published comparing VKAs and DOACs in treatment of LVT [17][18][19][20][21][22][23][24]. However, these meta-analyses included only direct comparative studies between VKAs and DOACs, and did not include single-arm studies.…”

Section: Introductionmentioning

confidence: 99%

Therapeutic efficacy of direct oral anticoagulants and vitamin K antagonists for left ventricular thrombus: Systematic review and meta-analysis

et al. 2021

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Background Although several meta-analyses have compared efficacies of vitamin K antagonists (VKAs) and direct oral anticoagulants (DOACs) for treatment of left ventricular thrombus (LVT), those meta-analyses included no single-arm studies. Methods and results PubMed, Scopus, and the Cochrane Library databases were searched for articles investigating thrombus resolution, stroke, any thromboembolism, major bleeding, any bleeding, or all-cause death in LVT treated with VKAs or DOACs, and single-class meta-analyses were also included (PROSPERO database, CRD42021230849). Event rates were pooled using a random effects model. Meta-regression analysis was performed to explore factors that may influence outcomes. 2,612 patients from 23 articles were included (VKAs: 2,004, DOACs: 608). There were no significant differences between VKAs and DOACs in the frequency of thrombus resolution (VKAs: 0.75 [95% confidence interval; 0.67 to 0.81], DOACs: 0.75 [0.67 to 0.82]), stroke (VKAs: 0.06 [0.04 to 0.10], DOACs: 0.02 [0.01 to 0.01]), any thromboembolism (VKAs: 0.08 [0.05 to 0.13], DOACs: 0.03 [0.01 to 0.10]), major bleeding (VKAs: 0.06 [0.04 to 0.09], DOACs: 0.03 [0.01 to 0.06]), any bleeding (VKAs: 0.08 [0.05 to 0.12], DOACs: 0.08 [0.06 to 0.10]), and all-cause death (VKAs: 0.07 [0.04 to 0.13], DOACs: 0.09 [0.05 to 0.16]). Meta-regression analysis revealed that increased duration of follow-up was associated with lower-rates of stroke (estimate: -0.040, p = 0.0495) with VKAs, but not with DOACs. There was significant publication bias for thrombus resolution, stroke, any thromboembolism, any bleeding, and all-cause death. Conclusions Efficacy and adverse outcomes of therapy with DOACs and VKAs do not differ. Randomized controlled trials are needed to determine the optimal anticoagulant strategy.

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“…Результаты комбинированной конечной точки по инсульту и периферической эмболии также показали превосходство ПОАК над варфарином (p=0,0001) [44]. По данным большого числа мета-анализов и систематических обзоров, ПОАК не уступают АВК по эффективности и безопасности при тромбозе ЛЖ и могут служить им достойной альтернативой [45][46][47][48][49][50][51]. Стоит отметить, что из-за ограниченного количества статей и рандомизированных исследований встречаются мета-анализы с противоречивыми выводами.…”

Section: результаты наблюдательных исследованийunclassified

Left Ventricular Thrombosis: Current Perspective and Use of Direct Oral Anticoagulants

Aga

Соколова

2023

Racionalʹnaâ farmakoterapiâ v kardiologii

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Left ventricular thrombus (LVT) is a serious risk factor for systemic embolism development. Despite the evident danger of this condition, current guidelines describe management of patients with this potentially fatal complication very briefly. LVT can complicate myocardial infarction where its incidence is around 10%, as well as various forms of cardiomyopathies and novel coronavirus infection. According to clinical guidelines vitamin K antagonists (VKAs) should be used as treatment of choice for thrombus resolution. However, experts point out that this therapy lacks necessary evidential base and bears certain difficulties because of pharmacokinetic and pharmacodynamical properties of VKAs. These drawbacks are absent in direct oral anticoagulants (DOACs), the possibility of using which in LVT is being actively studied. As for now, published results of 3 randomised clinical trials have demonstrated similar safety and efficacy profiles of DOACs and VKAs. Similarly, the majority of retrospective cohort studies did not observe significant differences between two groups, where some of them have shown superiority of DOACs especially in terms of earlier thrombus resolution. Nevertheless, some studies have found DOACs ineffective and even potentially unsafe regarding systemic embolism. Existing data does not allow to form an unambiguous conclusion about the equivalence of DOACs and VKAs for LVT resolution. Large randomised clinical trials are needed to determine efficacy and safety of such treatment in these patients.

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Direct oral anticoagulants vs. vitamin K antagonists for left ventricular thrombus: a systematic review and meta-analysis

Cited by 12 publications

References 40 publications

Different Oral Antithrombotic Therapy for the Treatment of Ventricular Thrombus: An Observational Study from 2010 to 2019

Different Oral Antithrombotic Therapy for the Treatment of Ventricular Thrombus: An Observational Study from 2010 to 2019

Therapeutic efficacy of direct oral anticoagulants and vitamin K antagonists for left ventricular thrombus: Systematic review and meta-analysis

Left Ventricular Thrombosis: Current Perspective and Use of Direct Oral Anticoagulants

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