Meta-Analysis Investigating the Role of Direct Oral Anticoagulants Versus Vitamin K Antagonists in the Treatment of Left Ventricular Thrombi

Abstract Funding Acknowledgements Type of funding sources: None. Background Left ventricular (LV) thrombus is a current clinical problem. The incidence of systemic embolism (SE) is up to 16% in these patients and international guidelines recommend anticoagulation with vitamin-K antagonists (VKAs). Data on direct oral anticoagulants (DOACs) for LV thrombus is increasing but still with conflicting results. Methods We performed a systematic review and meta-analysis of studies assessing the efficacy of DOACs versus VKAs in LV thrombus resolution, SE events and/or stroke and bleedings events. We systematically searched PubMed and Cochrane database for studies comparing DOACs versus VKAs as anticoagulant strategy for LV thrombus. Random-effects meta-analysis was performed. Results Four studies were included: n= 727 patients (DOACs group – 243 patients vs VKAs group – 484 patients). There is a 40% reduction in the odds for achieving thrombus resolution in the group of patients treated with DOACs (pooled OR 0.60; 95% CI 0.43-0.85; I2 =0%; P = 0.003) - Figure 1A. No difference between groups for the odds of SE and/or stroke was observed during follow-up (pooled OR 1.75; 95% CI 0.92-3.35; I2 =0%; P = 0.09) - Figure 1B. Bleedings events were not different between both anticoagulant strategies (pooled OR 0.65; 95% CI 0.30-1.39; I2= 0%, P = 0.26) - Figure 1C. Conclusion Although probably with less efficacy for thrombus resolution, the use of DOAC for LV thrombus does not seem to increase the risk of SE and/or stroke or bleedings events compared to VKAs. Abstract Figure 1 - Pooled analysis (DOAC vs VKA)

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Management of left ventricular thrombi with direct oral anticoagulants: Retrospective comparative study with vitamin K antagonists

Archives of Cardiovascular Diseases Supplements ◽

10.1016/j.acvdsp.2020.10.167 ◽

2021 ◽

Vol 13 (1) ◽

pp. 74

Author(s):

J. Daher ◽

A. Da Costa ◽

C. Hilaire ◽

T. Ferreira ◽

R. Pierrard ◽

...

Keyword(s):

Comparative Study ◽

Vitamin K ◽

Vitamin K Antagonists ◽

Oral Anticoagulants ◽

Direct Oral Anticoagulants ◽

Left Ventricular ◽

Retrospective Comparative Study ◽

Left Ventricular Thrombi

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21 Direct oral anticoagulants vs. vitamin K antagonists in the treatment of left ventricular thrombosis: a systematic review and meta-analysis

European Heart Journal Supplements ◽

10.1093/eurheartj/suab131.003 ◽

2021 ◽

Vol 23 (Supplement_G) ◽

Author(s):

Francesco Condello ◽

Matteo Maurina ◽

Mauro Chiarito ◽

Matteo Sturla ◽

Riccardo Terzi ◽

...

Keyword(s):

Ischaemic Stroke ◽

Vitamin K ◽

Meta Analysis ◽

Vitamin K Antagonists ◽

Oral Anticoagulants ◽

Direct Oral Anticoagulants ◽

Left Ventricular ◽

Clinical Effects ◽

Significant Difference ◽

Secondary Endpoints

Abstract Aims Evidence about the use of direct oral anticoagulants (DOACs) in patients with left ventricular thrombosis (LVT) are emerging. The aim of our study was to provide a comprehensive synthesis of the available evidence concerning the clinical effects of DOACs vs. vitamin K antagonists (VKAs) in LVT treatment. Methods Systematic search of studies evaluating DOACs vs. VKAs use in patients with LVT was performed on 11 May 2021. Data were pooled by meta-analysis using a random-effects model. Odds ratios (OR) with relative 95% confidence intervals (CI) were used as measures of effect estimates. The primary efficacy and safety endpoint were ischaemic stroke and any bleeding, respectively. Secondary endpoints were LVT resolution, systemic embolism, major bleeding, haemorrhagic stroke, and all cause death. Results Twenty studies were included in the meta-analysis: 1391 patients were treated with DOACs and 1534 with VKAs. A significant reduction in the risk of ischaemic stroke [OR 0.67, 95% CI 0.45–0.98, P = 0.048, number needed to treat to benefit (NNTB) 22 (95% CI 15–43)] and any bleeding [OR 0.64, 95% CI 0.46–0.89, P = 0.009, NNTB 26 (95% CI 16–80)] was observed with DOACs compared to VKAs. No statistically significant difference was observed among the two treatment arms for the secondary endpoints. Conclusion Compared to VKAs, DOACs are associated with a reduced risk of ischaemic stroke and bleeding. In light of these findings, and the practical advantages of DOACs, additional large scale randomized controlled trials are needed to confirm the benefits of DOACs in patients with LVT.

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