Direct oral anticoagulants versus warfarin for the treatment of left ventricular thrombosis

Mihm, Alexandra E.; Hicklin, Harry E; Cunha, Alexandra L; Nisly, Sarah A.; Davis, Kyle

doi:10.1007/s11739-021-02788-8

Cited by 16 publications

(42 citation statements)

References 11 publications

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“…Ischaemic cardiomyopathy (ICM) and AMI were found to be the major aetiologies of LVT 14,16–18,21,23,25,28–30,33,34 . Most studies had used transthoracic echocardiography (TTE) to diagnose LVT, while some studies had used cardiac magnetic resonance imaging (CMRI) or others as auxiliary diagnostic methods 17,23–27 . Follow‐up duration ranged between 3 and 44 months.…”

Section: Resultsmentioning

confidence: 99%

“…Among these studies, 14.0% of patients on DOACs and 22.3% of patients on VKAs had died, but no statistical difference was observed between the two groups (RR = 0.72, 95% CI = 0.52–1.00, P = 0.05, I 2 = 11%; Figure ). Bleeding events, as the main safety endpoint of LVT treatment, were reported in 16 studies 14–16,18,19,21–25,27,29–31,33,34 . In those studies, 10.9% of patients treated with DOACs and 14.3% of patients treated with VKAs were reported to have had bleeding events with a significant difference between the two groups (RR = 0.73, 95% CI = 0.58–0.90, P = 0.004, I 2 = 0%, Figure ).…”

Section: Discussionmentioning

confidence: 99%

“…We used RevMan software version 5.4 and Stata/MP 16.0 to combine and analyse outcomes from the included studies 14–34 . Risk ratios (RRs) with 95% confidence intervals (CIs) were used to evaluate differences between patients in the DOACs and VKAs groups.…”

Section: Methodsmentioning

confidence: 99%

“…However, DOACs are used off‐label as anticoagulant treatment in patients with LVT. To date, several case studies, observational studies, and randomized control trials (RCTs) have suggested analogous or contradictory safety and efficacy when comparing DOACs with VKAs to treat LVT 13–34 . A few meta‐analyses have drawn varied conclusions in terms of efficacy and safety between DOACs and VKAs, 35,36 predominantly suggesting that DOACs use may be promising when treating patients with LVT.…”

Section: Introductionmentioning

confidence: 99%

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Systematic review of efficacy of direct oral anticoagulants and vitamin K antagonists in left ventricular thrombus

2022

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Aims Left ventricular thrombus (LVT) increases the risk of thrombotic events and mortality. Vitamin K antagonists (VKAs) used to treat LVT have several known risks, as a result of which direct oral anticoagulant (DOAC) use has recently increased. We aimed to evaluate the safety and efficacy of DOACs and VKAs in treating LVT. Methods and results We searched PubMed, Embase, Cochrane Library trials, and Web of Science databases for studies published before 19 April 2022, involving DOAC versus VKA treatment for patients with LVT. This meta‐analysis comprised 21 studies (total patients, n = 3172; DOAC group, n = 888; VKA group, n = 2284). A statistically significant reduction in bleeding events was observed in patients on DOACs vs. those on VKAs (risk ratio (RR) = 0.73, P = 0.004). Patients on DOACs residing in North American and European regions and those with ischaemic heart disease (IHD) had a significantly lower risk of bleeding events than patients residing in other regions or those with a different LVT aetiology, respectively (RR = 0.78, P = 0.04; RR = 0.38, P = 0.02; and RR = 0.63, P = 0.009). A statistically significant reduction in stroke in patients on DOACs versus VKAs (RR = 0.72, P = 0.03) was observed, and patients on DOACs residing in North America and those with IHD had a significantly lower risk of stroke (RR = 0.73, P = 0.04, and RR = 0.61, P = 0.03, respectively). Compared with VKAs, DOACs are statistically associated with an increase in LVT resolution at 1 month (RR = 1.96, P = 0.008). No statistical between‐group difference in all‐cause mortality (RR = 0.72, P = 0.05), systemic embolism (RR = 0.87, P = 0.74), stroke or systemic embolism (RR = 0.90, P = 0.50), and LVT resolution at the end of follow‐up (RR = 1.06, P = 0.13) was observed. Conclusions Compared with VKAs, DOACs significantly reduce the risk of bleeding events and stroke in LVT patients, but mortality was similar in both groups. The advantages are apparent not only in patients belonging to the predominantly white residential areas such as North American and European regions but also in patients with LVT due to IHD. DOACs show promising effects in treating LVT compared with VKAs.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Systematic review of efficacy of direct oral anticoagulants and vitamin K antagonists in left ventricular thrombus

2022

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“…No stroke or embolism events were observed, and only one patient experienced nonfatal bleeding. Numerous studies claimed that NOACs were comparable with or even outweighed VKAs [28,[33][34][35][36][37]39,40,[45][46][47], and obviously the most popular or dominant usage of NOACs was rivaroxaban in all studies. It was known that NOACs could be divided into two types targeting various action mechanismanti-Xa inhibitor (rivaroxaban, apixaban and edoxaban or anti-IIa inhibitors (dabigatran).…”

Section: Discussionmentioning

confidence: 99%

A Meta-Analysis Comparing Different Oral Anticoagulation for the Treatment of Ventricular Thrombus

Yang¹,

He²,

Quan³

et al. 2022

Rev. Cardiovasc. Med.

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Background: Patients with ventricular thrombus (VT) require anticoagulation therapy and it remains unknown that whether non-vitamin K antagonist oral anticoagulants (NOACs) or vitamin K antagonists (VKAs) are more effective. Objective: We aimed to compare the effectiveness and safety of NOACs with VKAs on the rate of thrombus resolution and clinical outcomes. Methods: MEDLINE, PUBMED, EMBASE, Cochrane Library, Web of Science, China National Knowledge Infrastructure Database and Wanfang Database, were searched up to November 22, 2021. The primary outcome was the rate of thrombus resolution, and the secondary outcomes were bleeding, stroke or systemic embolism (SSE), stroke and all-cause death. Odds ratio (OR) and 95% confidential intervals (CI) were used for the pooled results. Results: Eighteen studies with 1755 participants (NOACs, n = 607; VKAs, n = 1148) were included. There were no significant differences in thrombus resolution (OR 0.92, 95% CI 0.68-1.23, p = 0.558), bleeding (OR 0.85, 95% CI 0.54-1.35, p = 0.496), SSE (OR 0.77, 95% CI 0.41-1.43, p = 0.401), stroke (OR 0.65, 95% CI 0.29-1.49, p = 0.312) or all-cause death (OR 1.02, 95% CI 0.63-1.67, p = 0.925) between NOACs and VKAs. Subgroup analyses showed a statistics difference in thrombus resolution between NOACs and VKAs among studies which enrolled patients with or without dabigatran (Yes: OR 0.80, 95% CI 0.59-1.08; No: OR 1.48, 95% CI 1.00-2.19; p = 0.01), while no significances were observed according to baseline characteristics. Conclusions: Our findings showed that NOACs were comparable to VKAs in thrombus resolution as well as clinical outcomes. In studies that enrolled patients without dabigatran, the thrombus resolution seemed to be greater in NOACs group than VKAs group. And in different proportion of baseline left ventricular ejection fraction, history of ischemic cardiomyopathy and combination with antiplatelet, the thrombus resolution among the two groups remained similar.

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Direct oral anticoagulants (DOAC) versus vitamin K antagonist in left ventricular thrombus: An updated meta‐analysis

Shrestha,

Dawadi,

Dhakal

et al. 2023

Health Science Reports

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Background and AimsCurrent clinical guidelines for treating left ventricular thrombus (LVT) are limited by inadequate evidence to inform the comparative efficacy of oral anticoagulants. In this meta‐analysis, we aimed to compare the efficacy and safety of direct oral anticoagulants (DOAC) to vitamin K antagonists (VKA) in patients with LVT.MethodsFour standard databases were searched for relevant literature comparing the efficacy and safety between DOAC and VKA for LVT treatment, published before August 19, 2023. Both the randomized controlled trials and observational studies were included in the analysis. The outcomes of interest were the resolution of LVT, all‐cause mortality, stroke, systemic embolism, and bleeding. Data from the selected studies were extracted and analyzed using RevMan 5.4 using odds ratio.ResultsAmong 3959 studies from the database search and bibliography review, 33 were included in the analysis. LVT resolution was observed in 72.59% in the DOAC group versus 67.49% in the VKA group (odds ratio [OR]: 1.28, confidence interval [CI]: 1.07–1.53). Mortality was lower in the DOAC group (11.71% vs. 18.56%) (OR: 0.60, CI: 0.36–1.00; borderline statistical significance). Likewise, bleeding events (9.60% vs. 13.19%) (OR: 0.65, CI: 0.52–0.81) and stroke (7.54% vs. 11.04%) (OR: 0.71, CI: 0.53–0.96) were also significantly lower in the DOAC group.ConclusionDOAC use for LVT showed better thrombus resolution and reduced risk of bleeding and stroke compared to VKA. Likewise, DOAC use was associated with lower mortality with borderline statistical significance.

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Direct oral anticoagulants versus warfarin for the treatment of left ventricular thrombosis

Cited by 16 publications

References 11 publications

Systematic review of efficacy of direct oral anticoagulants and vitamin K antagonists in left ventricular thrombus

Systematic review of efficacy of direct oral anticoagulants and vitamin K antagonists in left ventricular thrombus

A Meta-Analysis Comparing Different Oral Anticoagulation for the Treatment of Ventricular Thrombus

Direct oral anticoagulants (DOAC) versus vitamin K antagonist in left ventricular thrombus: An updated meta‐analysis

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