scholarly journals Direct oral anticoagulants versus vitamin-K antagonists for left ventricular thrombus - a systemic review and meta-analysis

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
C Saleiro ◽  
J Lopes ◽  
D Campos ◽  
L Puga ◽  
M Costa ◽  
...  
Keyword(s):  
Vitamin K ◽  
Meta Analysis ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Clinical Problem ◽  
Pooled Analysis ◽  
Left Ventricular ◽  
Systemic Review ◽  
Funding Sources

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)

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

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.

scholarly journals Meta-analysis comparing direct oral anticoagulants versus vitamin K antagonists in patients with left ventricular thrombus

PLoS ONE ◽  
2021 ◽  
Vol 16 (6) ◽  
pp. e0252549
Author(s):  
Kazuhiko Kido ◽  
Yasir Abdul Ghaffar ◽  
James C. Lee ◽  
Christopher Bianco ◽  
Mikiko Shimizu ◽  
...  
Keyword(s):  
Vitamin K ◽  
Meta Analysis ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Left Ventricular ◽  
Left Ventricular Thrombus ◽  
Cochrane Library ◽  
Small Scale ◽  
Ventricular Thrombus

Current American College of Cardiology/American Heart Association guidelines for stroke or ST-elevation myocardial infarction recommend the use of oral vitamin K antagonists (VKAs) as a first-line anticoagulant. Although several studies have compared the use of direct oral anticoagulants (DOACs) to VKAs for left ventricular thrombus (LVT) anticoagulation therapy, they are small scale and have produced conflicting results. Thus, this meta-analysis was performed to aggregate these studies to better compare the efficacy and safety of DOACs with VKAs in patients with LVT. Cochrane Library, Google Scholar, MEDLINE, and Web of Science database searches through January 10, 2021 were performed. Eight studies evaluating stroke or systemic embolism (SSE), six studies for LVT resolution, and five studies for bleeding were included. There were no statistically significant differences in SSE (OR 0.89; 95% CI 0.46, 1.71; p = 0.73; I2 = 45%) and LVT resolution (OR 1.13; 95% CI 0.75, 1.71; p = 0.56; I2 = 1%) between DOAC and VKA (reference group) therapy. DOAC use was significantly associated with lower bleeding event rates compared to VKA use (OR 0.61; 95% CI 0.40, 0.93; p = 0.02; I2 = 0%). DOACs may be feasible alternative anticoagulants to vitamin K antagonists for LV thrombus treatment. Randomized controlled trials directly comparing DOACs with VKAs are needed.

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