Management of Left Ventricular Thrombi with Direct Oral Anticoagulants: Retrospective Comparative Study with Vitamin K Antagonists

Daher, Jessica; Costa, Antoine Da; Hilaire, Christophe; Ferreira, Thomas; Pierrard, Romain; Guichard, Jean-Baptiste; Romeyer, Cécile; Isaaz, Karl

doi:10.1007/s40261-020-00898-3

Cited by 64 publications

(79 citation statements)

References 47 publications

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“…These results are consistent with results seen in some prior retrospective studies, where safety and e cacy of DOAC was comparable to warfarin for SSE prevention. [12,14,24,25] Our results are contrary to those of Robinson et al, who reported that treatment with DOACs was associated with a higher risk of SSE compared to warfarin. [13] It is important to note that in this study, DOAC group had more patients with traditional risk factors of stroke like history of prior SSE, hyperlipidemia, atrial brillation, apical thrombus and pedunculated thrombus which could have contributed to more SSE events.…”

Section: Discussioncontrasting

confidence: 99%

Warfarin Versus Direct Oral Anticoagulants for Treating Left Ventricular Thrombus: A Systematic Review and Meta-Analysis

Dalia

Lahan

Ranka

et al. 2020

Preprint

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Background: Left ventricular thrombus (LVT) is not uncommon and pose a risk of systemic embolism, which can be mitigated by adequate anticoagulation. Direct oral anticoagulants (DOACs) are increasingly being used as alternatives to warfarin for anticoagulation, but their efficacy and safety profile has been debated. We aim to compare the therapeutic efficacy and safety of DOACs versus warfarin for the treatment of LVT.Methodology: We systematically searched PubMed/Medline, Google Scholar, Cochrane library, and LILCAS databases from inception to 14th August 2020 to identify relevant studies comparing warfarin and DOACs for LVT treatment and used the pooled data extracted from retrieved studies to perform a meta-analysis.Results: We report pooled data on 1955 patients from 8 studies, with a mean age of 61 years and 59.7 years in warfarin and DOACs group, respectively. The pooled odds ratio for thrombus resolution was 1.11 (95% CI 0.51–2.39) on comparing warfarin to DOAC, but it did not reach a statistical significance (p = 0.76). The pooled risk ratio (RR) of stroke or systemic embolization and bleeding in patients treated with warfarin vs DOACs was 1.04 (95% CI 0.64–1.68; p = 0.85), and 1.15 (95% CI 0.62–2.13; p = 0.57), respectively; with an overall RR of 1.09 (95% CI 0.70–1.70; p =0.48) for mortality.Conclusions: DOACs appears to be non-inferior or at least as effective as warfarin in the treatment of left ventricular thrombus without any statistical difference in stroke or bleeding complications.

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Section: Discussioncontrasting

confidence: 99%

Warfarin Versus Direct Oral Anticoagulants for Treating Left Ventricular Thrombus: A Systematic Review and Meta-Analysis

Dalia

Lahan

Ranka

et al. 2020

Preprint

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“…Ten studies reported the occurrence of SSE [5][6][7][8][9][20][21][22][23][24][25] . The NOACs group and VKAs group did not show a significant difference in the risk of SSE (RR:0.96, 95% CI: 0.80-1.16, P = 0.69; I 2 = 0%, figure 3A).…”

Section: Stroke and Embolic Eventsmentioning

confidence: 99%

“…Eleven studies investigated the outcome of failure in thrombus resolution [5][6][7][8][9][16][17][18][19]21,22,24,25 , and the resolution rate was similar in two groups (RR: 0.88, 95% CI: 0.72-1.09, P = 0.20, Figure 2C Supplementary figure 3C). Efficacy for thrombus resolution was consistent despite follow-up duration (P interaction = 0.94), sample size (P interaction = 0.26) and anti-platelet medication (P interaction = 0.43) in subgroup analysis ( Table 2).…”

Section: Thrombus Resolutionmentioning

confidence: 99%

“…The copyright holder for this this version posted December 11, 2020. ; https://doi.org/10.1101/2020.12.08.20246330 doi: medRxiv preprint using NOACs [6][7][8][9] . Although the current analysis suggested no difference between NOACs and VKAs for their efficacy in SSE prevention, as reported by other recently published meta-analysis 21,27 , it was definitely of great clinical importance as it showed a 32% risk reduction for strokes alone in NOACs users.…”

Section: Efficacy Of Noacs and Vkasmentioning

confidence: 99%

“…Current guidelines recommend vitamin K antagonists (VKAs) for LVT patients based on limited evidence from observational studies [1][2][3][4] . However, off-label use of novel oral anticoagulants (NOACs) for LVT is gaining interest, as they provide more constant anticoagulant effects and do not require continuous monitor of international normalized ratio (INR) 1,[5][6][7][8][9] . Numerous trials and analysis have already proved NOACs acquire similar efficacy in SSE prevention and lower bleeding risk in other clinical scenarios (e.g.…”

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confidence: 99%

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Novel Oral Anticoagulants versus Vitamin K Antagonists for Patients with Left Ventricular Thrombus: A Systematic Review and Meta-Analysis

Chen¹,

Zhou²,

Liu³

et al. 2020

Preprint

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BackgroundAlthough vitamin K antagonists (VKAs) are recommended as first-line anticoagulants for patients with left ventricular thrombus (LVT), accumulating evidence suggests novel oral anticoagulants (NOACs) could be safe alternatives for VKAs. Efficacy and safety of NOACs should be assessed to justify their usage for LVT patients.DesignWe performed a meta-analysis of observational studies to evaluate the efficacy and safety of NOACs as compared to VKAs in LVT patients.MethodsPubMed and EMBASE databases were searched for articles published until November 12, 2020. Two reviewers independently extracted relevant information from articles and assessed the study quality. Pooled effects were estimated using Mantel–Haenssel method and presented as risk ratios (RR) using fixed-effect model. Reporting followed the Meta-analyses Of Observational Studies in Epidemiology (MOOSE) guideline.ResultsA total of 2467 LVT patients from 13 studies were included. Compared with VKAs, NOACs showed similar efficacy in prevention of stroke or systemic embolism (RR: 0.96, 95% confidence interval [CI]:0.80-1.16, P = 0.68) and thrombus resolution (RR: 0.88, 95% CI: 0.72-1.09, P = 0.20), but significantly reduced the risk of stroke (RR: 0.68, 95% CI: 0.47-1.00, P < 0.05). For safety outcomes, NOACs users showed similar risk of any bleedings (RR: 0.94, 95% CI: 0.67-1.31, P = 0.70), but lower risk of clinically relevant bleedings (RR: 0.35, 95% CI: 0.13-0.92, P = 0.03) compared with VKAs users.ConclusionsCompared with VKAs, NOACs acquired similar efficacy and safety profile for patients with LVT, but could reduce the risk of strokes and clinically relevant bleedings.

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Assessment of non‐vitamin K antagonist oral anticoagulants for the management of left ventricular thrombus

Deng

Tong

et al. 2021

Clinical Cardiology

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Although several studies have assessed the effect of non‐vitamin K antagonist oral anticoagulants (NOACs) relative to that of vitamin K antagonists (VKAs) in patients with left ventricular thrombus, the results remain controversial. Herein, a meta‐analysis was performed to compare the effectiveness and safety of NOACs versus VKAs for the treatment of left ventricular thrombus. We systematically searched the Cochrane Library, PubMed and Embase databases until November 2020 for studies that compared the effects of NOACs versus VKAs in patients with left ventricular thrombus. The treatment effects were expressed as odds ratios (ORs) with 95% confidence intervals (CIs) and pooled by a random‐effects model. Seven retrospective studies involving 865 patients with left ventricular thrombus (266 NOAC and 599 VKA users) were included. The pooled analysis suggested no difference in the rate of thrombus resolution between the NOAC and VKA groups (OR = 0.83, 95% CI 0.61–1.13). There were also no differences in the rates of stroke or systemic embolism (OR = 0.62, 95% CI 0.20–1.97), bleeding events (OR = 0.73, 95% CI 0.37–1.45), or all‐cause death (OR = 0.92, 95% CI 0.50–1.69) between patients treated with NOACs and those treated with VKAs. In addition, the rates of thrombus resolution, stroke or systemic embolism, bleeding events, and all‐cause death between NOAC‐ and warfarin‐treated patients were also similar. Our current evidence suggested that NOAC and VKA users had similar rates of thrombus resolution and clinical outcomes among patients with left ventricular thrombus. Further large‐scale prospective studies should confirm our results.

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Management of Left Ventricular Thrombi with Direct Oral Anticoagulants: Retrospective Comparative Study with Vitamin K Antagonists

Cited by 64 publications

References 47 publications

Warfarin Versus Direct Oral Anticoagulants for Treating Left Ventricular Thrombus: A Systematic Review and Meta-Analysis

Warfarin Versus Direct Oral Anticoagulants for Treating Left Ventricular Thrombus: A Systematic Review and Meta-Analysis

Novel Oral Anticoagulants versus Vitamin K Antagonists for Patients with Left Ventricular Thrombus: A Systematic Review and Meta-Analysis

Assessment of non‐vitamin K antagonist oral anticoagulants for the management of left ventricular thrombus

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