Comparative effectiveness of direct oral anticoagulants and warfarin for the treatment of left ventricular thrombus

Bass, Megan; Kiser, Tyree H.; Page, Robert L.; McIlvennan, Colleen K.; Allen, Larry A.; Wright, Garth; Shakowski, Courtney

doi:10.1007/s11239-020-02371-6

Cited by 51 publications

(62 citation statements)

References 19 publications

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“…A total of 122 articles were evaluated for eligibility, and eight studies were included for the final analysis ( Fig 1 ) [ 11 – 13 , 15 , 18 – 21 ]. One study was excluded because the comparison of VKA with DOACs was not the primary study purpose and less than 5 patients on DOACs were included [ 10 ].…”

Section: Resultsmentioning

confidence: 99%

“…Despite enrolling a large number of patients on triple antithrombotic therapy (68.3% DOAC vs 70.0% VKA), Jones et al found less major bleeding with DOAC use compared to VKA (0% vs 6.7%, p = 0.030) [ 18 ]. Bass et al, on the other hand, observed comparable bleeding events (10.9% vs 7.8%, p = 0.40) between warfarin and DOAC therapy, although more warfarin patients received blood products compared to those taking a DOAC (25.8% vs 13.9%, p < 0.001) [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

“…LVT formation is pathologically similar to left atrial appendage thrombus (LAAT) formation due to a low-flow and low-shear setting, with DOAC use for left atrial appendage thrombi (LAAT) appearing to be highly efficacious [ 10 ]. Correspondingly, the safety and efficacy of DOACs observed in the prevention of thromboembolism and stroke in atrial fibrillation have served as a basis for DOAC use for LVT anticoagulation [ 11 – 14 ]. Since the publication of ACC/AHA guidelines in 2013, multiple studies and case series have compared DOACs with VKAs in patients with LVT but have produced discordant results.…”

Section: Introductionmentioning

confidence: 99%

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

Kido

Ghaffar

Lee³

et al. 2021

PLoS ONE

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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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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Kido

Ghaffar

Lee³

et al. 2021

PLoS ONE

View full text Add to dashboard Cite

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“…Moreover, they reported a higher rate of bleed with DOAC and no difference in thromboembolic complications [14]. On the other hand, Bass and colleagues reported higher blood transfusion requirements in patients who received warfarin than DOAC and no difference in other outcomes [15].…”

Section: Discussionmentioning

confidence: 99%

Rivaroxaban versus warfarin for the management of left ventricle thrombus

et al. 2021

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Background Rivaroxaban has been recently introduced for the management of non-valvular intra-cardiac thrombosis with variable results. We aimed to compare the results of the off-label use of rivaroxaban versus warfarin in the management of patients with left ventricle (LV) thrombus. This research is a retrospective study conducted on 63 patients who had LV thrombus from January to December 2016. We compared patients treated with warfarin (n=35) to patients who had rivaroxaban (n=28), and study outcomes were time to thrombus resolution, bleeding, stroke, and mortality. Results The median duration of treatment was 9.5 (25th-75th percentiles: 6-32.5) months for rivaroxaban and 14 (3-41) months for warfarin. Thrombus resolution occurred in 24 patients in the warfarin group (68.6%) and 20 patients in the rivaroxaban group (71.4%). The median time to resolution in the warfarin group was 9 (4-20) months and 3 (2-11.5) months in the rivaroxaban group. Thrombus resolution was significantly faster in patients on rivaroxaban (p= 0.019). Predictors of thrombus resolution were thrombus surface area (HR: 1.21; CI 95% (1.0-1.46); p= .048) and the use of rivaroxaban (HR: 1.92; CI 95% (1.01-3.65); p= 0.048). There was no difference in stroke, bleeding, and mortality between both groups. Conclusion Rivaroxaban was as effective and safe as warfarin in managing patients with left ventricle thrombus. Larger randomized clinical trials are recommended to confirm our findings.

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“…In the left 100 articles, 57 studies were excluded for not investigating patients with LVT, 30 studies for without comparison between VKAs and NOACs, and 1 for animal study. Finally, we performed full-text screening on the remaining 12 documents: 3 of them were excluded for not being done ( 17 – 19 ), and 3 were duplicate researches ( 20 – 22 ). Then six studies left for subsequent data analyses with sample sizes ranged from 59 to 421 ( 10 – 13 , 23 , 24 ).…”

Section: Resultsmentioning

confidence: 99%

Safety and Efficacy of Vitamin K Antagonists vs. Novel Oral Anticoagulants in Patients With Left Ventricular Thrombus: A Meta-Analysis

Chen

Dai

et al. 2021

Front. Cardiovasc. Med.

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Aims: A meta-analysis was conducted to evaluate the safety and efficacy of novel oral anticoagulants (NOACs) compared with vitamin K antagonists (VKAs) in patients with left ventricular thrombus (LVT).Methods and Results: We searched PubMed, Web of Science, and Cochrane Library for cohort studies comparing the use of VKAs vs. NOACs for the treatment of LVT from the earliest date available to September 30, 2020. The predetermined efficacy and safety outcomes included thromboembolic events, resolution of LVT, clinically significant bleedings, and all-cause death. Fixed-effects model was used to estimate the pooled effects. Publication bias analyses and sensitivity analyses were conducted to check the robustness of results. A total of 6 studies enrolling 837 patients (mean age 60.2 ± 1.6 years; 77.2% were male) were included. We found no significant differences in thromboembolic events [relative risk (RR) 1.69, 95% confidence interval (CI) 0.94–3.06, P 0.08, I2 12.7%], the rate of resolution of thrombus (RR 1.08, 95% CI 0.96–1.21, P 0.21, I2 4.8%), and clinically significant bleedings (RR 0.70, 95% CI 0.37–1.32, P 0.27, I2 0%) between the VKAs and NOACs group. Additionally, no significant difference in all-cause mortality was found between the two groups (RR 1.24, 95% CI 0.79–1.96, P 0.35, I2 0.0%). Sensitivity analyses, using the “1-study removed” method, detected no significant differences.Conclusion: NOACs and VKAs have similar efficacy and safety in treating LVT, prompting the inference that NOACs are the possible alternatives of VKAs in LVT therapy.

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Comparative effectiveness of direct oral anticoagulants and warfarin for the treatment of left ventricular thrombus

Cited by 51 publications

References 19 publications

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

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

Rivaroxaban versus warfarin for the management of left ventricle thrombus

Safety and Efficacy of Vitamin K Antagonists vs. Novel Oral Anticoagulants in Patients With Left Ventricular Thrombus: A Meta-Analysis

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