Rivaroxaban versus Vitamin K Antagonists (warfarin) based on the triple therapy for left ventricular thrombus after ST-Elevation myocardial infarction

Zhang, Zhongfan; Si, Daoyuan; Zhang, Qian; Qu, Ming; Yu, Miao; Jiang, Zhenya; Li, Delin; Yang, Ping; Zhang, Wenqi

doi:10.1007/s00380-021-01921-z

Cited by 16 publications

(32 citation statements)

References 39 publications

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“…2 C). Regarding all-cause mortality, 7 studies (5 cohort studies and 2 RCTs, 714 patients) 9 , 10 , 12 , 13 , 17 , 21 , 23 were included in the meta-analysis. No significant difference was detected between DOACs and VKAs in LVT treatment (RR = 0.9, 95% CI, 0.58 to 1.4, P = 0.65, I 2 = 0%) (Fig.…”

Section: Resultsmentioning

confidence: 99%

Direct Oral Anticoagulants Versus Vitamin K Antagonists for the Treatment of Left Ventricular Thrombus: An Updated Meta-Analysis of Cohort Studies and Randomized Controlled Trials

Chen

Zhu

Wang

et al. 2022

Journal of Cardiovascular Pharmacology

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Section: Resultsmentioning

confidence: 99%

Direct Oral Anticoagulants Versus Vitamin K Antagonists for the Treatment of Left Ventricular Thrombus: An Updated Meta-Analysis of Cohort Studies and Randomized Controlled Trials

Chen

Zhu

Wang

et al. 2022

Journal of Cardiovascular Pharmacology

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“…However, the difference in size reduction or LVT resolution between the two groups was influenced by the therapeutic target of INR (TTR), diagnosis method, and the follow-up duration. The sub-optimal TTR may affect the resolution rate of LVT on VKAs, as mentioned in studies conducted by Alcalai et al, Ratnayake et al, Zhang et al 16,28,34 One previous study recommended performing LVT imaging using delayed enhancement CMRI and transesophageal echocardiography, with follow-up time points in the range of 3-12 months. 36 The diagnostic methods and follow-up duration of the included studies were not entirely consistent, which may have influenced our findings.…”

Section: Discussionmentioning

confidence: 99%

“…Baseline characteristics are shown in Table 1. The 21 included studies, comprising 3 RCTs 14,16,32 and 18 cohort studies 15,[17][18][19][20][21][22][23][24][25][26][27][28][29][30][31]33,34 had been published between 2019 and 2022. Studies were mainly conducted in North America, Europe, Africa, and Asia.…”

Section: Characteristics and Quality Of Included Studiesmentioning

confidence: 99%

“…We also analysed subgroups in terms of the incidence of stroke, stratified according to the aetiology of LVT, and observed that the incidence of stroke in the DOACs group was significantly lower than that in the VKAs group among patients with IHD (RR = 0.61, 95% CI = 0.39-0.96, P = 0.03, I 2 = 0%; Figure 3B). Ten studies 14,15,17,[22][23][24]27,31,33,34 reported SE data, in which SE occurred in 1.4% of patients on DOACs and 2.4% of patients on VKAs; however, this between-group difference was not statistically significant (RR = 0.87, 95% CI = 0.37-2.02, P = 0.74, I 2 = 0%; Figure 3C). Eighteen studies [14][15][16][17][18][19][20][21][22][23][24][25]27,[29][30][31]33,34 reported SSE outcomes, in which SSE occurred in 13.5% of patients on DOACs compared with 19.6% of patients on VKAs; however, SSE occurrences did not differ significantly between the two groups (RR = 0.90, 95% CI = 0.65-1.23, P = 0.50, I 2 = 23%; Figure 3D).…”

Section: Main Efficacy Outcomesmentioning

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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“…In this study, rivaroxaban versus VKAs was not found to have a benefit with regard to LV thrombus resolution; to test the stability of this finding, we used various statistical models, and the finding was generally consistent across statistical models, which was different from some previous LV thrombus-related studies in the non-HF setting (Abdelnabi et al, 2021;Jones et al, 2021;Zhang et al, 2022). The reason for this observation is unclear, which may be that the intrinsic differences of LV thrombus formation in various clinical settings contributed to the complicating interchangeability.…”

Section: Discussionmentioning

confidence: 68%

Rivaroxaban in heart failure patients with left ventricular thrombus: A retrospective study

Zhang

Zheng

et al. 2022

Front. Pharmacol.

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Background: The role of rivaroxaban in patients with heart failure (HF) combined with left ventricular (LV) thrombus remains unknown in current guideline-directed anticoagulant therapy. The aim of this study was to investigate the impact on clinical outcomes of rivaroxaban compared to vitamin K antagonists (VKAs) in patients with HF combined with LV thrombus.Methods: We retrospectively extracted clinical, echocardiographic and follow-up data of HF patients (all classifications) admitted at China-Japan Union Hospital of Jilin University from January 2017 to June 2021. A total of 198 patients with HF were identified with LV thrombus by echocardiography, 78 of them were managed with VKAs, 109 with rivaroxaban.Results: The median follow-up was 17.0 months (interquartile range: 6.0–24.0 months). High rates of major cardiovascular adverse events (MACEs) were observed in both the rivaroxaban and VKAs groups (49.5% vs. 57.7%). However, rivaroxaban versus VKAs observed a decrease in MACEs (adjusted HR:0.636; 95%CI:0.418–0.970; p = 0.035) and systemic embolism (4.6% vs. 12.8%; adjusted HR:0.318; 95%CI:0.108–0.933; p = 0.037; Gray’s test p = 0.041) but was not found to have a benefit with regard to LV thrombus resolution (59.6% vs. 70.6%; adjusted HR: 1.303; 95% CI:0.898–1.890; p = 0.163; Gray’s test p = 0.073). Additionally, there was no significant between-group difference in the rate of International Society on Thrombosis and Hemostasis (ISTH) bleeding events.Conclusion: Our data found that in populations with HF combined with LV thrombus, the overall prognosis in both the rivaroxaban and VKAs groups was catastrophic. Although rivaroxaban improved the prognosis to some extent, a considerable need remains for new treatments to improve their clinical course.

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Rivaroxaban versus Vitamin K Antagonists (warfarin) based on the triple therapy for left ventricular thrombus after ST-Elevation myocardial infarction

Cited by 16 publications

References 39 publications

Direct Oral Anticoagulants Versus Vitamin K Antagonists for the Treatment of Left Ventricular Thrombus: An Updated Meta-Analysis of Cohort Studies and Randomized Controlled Trials

Direct Oral Anticoagulants Versus Vitamin K Antagonists for the Treatment of Left Ventricular Thrombus: An Updated Meta-Analysis of Cohort Studies and Randomized Controlled Trials

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

Rivaroxaban in heart failure patients with left ventricular thrombus: A retrospective study

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