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

Abstract

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.

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

“…A few meta-analyses have drawn varied conclusions in terms of efficacy and safety between DOACs and VKAs, 35,36 predominantly suggesting that DOACs use may be promising when treating patients with LVT. However, no RCTs were included in the meta-analysis of Xuan et al, 35 resulting in a lack of clinical evidence. Almost 50% of the studies included in the study by Michael et al involved abstracts without complete experimental data, 36 which may influence the generalizability of their results.…”

“…To date, several case studies, observational studies, and randomized control trials (RCTs) have suggested analogous or contradictory safety and efficacy when comparing DOACs with VKAs to treat LVT. 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 A few meta‐analyses have drawn varied conclusions in terms of efficacy and safety between DOACs and VKAs, 35 , 36 predominantly suggesting that DOACs use may be promising when treating patients with LVT. However, no RCTs were included in the meta‐analysis of Xuan et al ., 35 resulting in a lack of clinical evidence.…”

“… 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 A few meta‐analyses have drawn varied conclusions in terms of efficacy and safety between DOACs and VKAs, 35 , 36 predominantly suggesting that DOACs use may be promising when treating patients with LVT. However, no RCTs were included in the meta‐analysis of Xuan et al ., 35 resulting in a lack of clinical evidence. Almost 50% of the studies included in the study by Michael et al .…”

Neuropsychiatric Systemic Lupus Erythematosus: Molecules Involved in Its Imunopathogenesis, Clinical Features, and Treatment

“…They are used to prevent and treat thromboembolic disorders, such as stroke, deep vein thrombosis, and pulmonary embolism. Some of the NOACs that have been approved [ 182 ] are: Dabigatran etexilate: a direct thrombin inhibitor that is approved for stroke prevention in atrial fibrillation, the prevention and treatment of venous thromboembolism, and the prevention of thromboembolism after hip or knee replacement surgery [ 183 ]; Rivaroxaban: a direct factor Xa inhibitor that is approved for stroke prevention in atrial fibrillation, the prevention and treatment of venous thromboembolism, the prevention of thromboembolism after hip or knee replacement surgery, and the secondary prevention of acute coronary syndrome [ 182 ]; Apixaban: a direct factor Xa inhibitor that is approved for stroke prevention in atrial fibrillation, the prevention and treatment of venous thromboembolism, and the prevention of thromboembolism after hip or knee replacement surgery [ 184 ]; Edoxaban: a direct factor Xa inhibitor that is approved for stroke prevention in atrial fibrillation and the treatment of venous thromboembolism [ 185 ]. …”

Clinical characteristics and prognosis of patients with left ventricular thrombus in East China

“…Most recently, the breakthrough of 2 novel randomized controlled trials have shown DOACs to be a promising treatment for LV thrombus. They also appealed that the optimal timing and type of anticoagulation for LV thrombus, and the role of screening for high-risk patients, should be tested in more prospective, randomized trials (17)(18)(19)(20)(21)(22)(23)(24)(25). We analyzed the relationship between baseline medication and mortality within 1 month and found aspirin/clopidogrel/ticagrelor + anticoagulant (HR, 0.066; 95% CI 0.011-0.403; p = 0.003) and aspirin + clopidogrel/ticagrelor + anticoagulant (HR, 0.059; 95% CI 0.004-0.804; p = 0.034) had protective effect on mortality.…”