Direct Oral Anticoagulants Are Effective Therapy in Treating Left Ventricular Thrombi

Yunis, Adil; Seese, Laura; Stearns, Blaise; Genuardi, Michael V.; Thoma, Floyd; Kilic, Arman

doi:10.1016/s0735-1097(20)31575-8

Cited by 22 publications

(69 citation statements)

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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%

“…[10,11] The effectiveness of DOACs in treating LV thrombus is controversial, with some studies favoring their use and others not. [11][12][13][14] The large scale studies and metanalysis comparing the effectiveness and, safety of the DOACs vs warfarin in treatment of LVT are lacking. Thus, we sought to perform this systematic review and metaanalysis to compare the effectiveness and safety of warfarin vs DOACs for the treatment of LVT.…”

Section: Introductionmentioning

confidence: 99%

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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%

Section: Introductionmentioning

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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“…Eight studies reported the outcome of strokes 6,9,[19][20][21][22]24,25 . NOACs users showed lower risk of stroke compared with VKAs users (RR: 0.68, 95% CI: 0.68-1.00, P < 0.05, Figure 2B).…”

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%

“…Nine studies reported bleeding events 6,9,16,[19][20][21][22]24,25 , the risk of any bleedings was similar for NOACs and VKAs users (RR: 0.94, 95% CI: 0.67-1.31, P = 0.70; I 2 = 24%, Figure 2D), without significant bias for publication as shown in the funnel plot (Supplementary figure 1D). Meta-regression showed age did not differentiate the safety of NOACs or VKAs (RR: 1.03, 95% CI: 0.81-1.31, P = 0.764, Supplementary figure 3D).…”

Section: Bleeding Eventsmentioning

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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Non-Vitamin K Antagonist Oral Anticoagulants Versus Warfarin for Patients With Left Ventricular Thrombus: A Systematic Review and Meta-Analysis

Gue

Spinthakis

Egred

et al. 2021

The American Journal of Cardiology

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Direct Oral Anticoagulants Are Effective Therapy in Treating Left Ventricular Thrombi

Cited by 22 publications

References 0 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

Non-Vitamin K Antagonist Oral Anticoagulants Versus Warfarin for Patients With Left Ventricular Thrombus: A Systematic Review and Meta-Analysis

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