The Role of Direct Oral Anticoagulants Versus Vitamin K Antagonists in the Treatment of Left Ventricular Thrombi: A Meta-Analysis and Systematic Review

Al-abcha, Abdullah; Herzallah, Khader; Saleh, Yehia; Mujer, Mark; Abdelkarim, Ola; Abdelnabi, Mahmoud; Abela, George S.

doi:10.1007/s40256-020-00458-2

Cited by 11 publications

(7 citation statements)

References 24 publications

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“…Additionally, patients treated with DOACs experienced significantly lower bleeding events compared to warfarin. The SSE and LVT resolution outcomes of this meta-analysis are congruent with the outcomes of other recently published meta-analyses [ 22 – 27 ]. Unlike previous meta-analyses, however, this meta-analysis only included fully published manuscripts and did not include abstracts due to their preliminary nature, which likely reduced the chance of error for data extraction [ 22 , 24 ].…”

Section: Discussionsupporting

confidence: 87%

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: Discussionsupporting

confidence: 87%

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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“…In recent years, the number of DOAC-related publications has increased dramatically, and articles reporting the efficacy and safety of DOACs in treatment of LVT are becoming increasingly common. To the best of our knowledge, six systematic reviews and meta-analyses comparing VKAs and DOACs for the treatment of LVT have been published in the last several years [17][18][19][20][21][22]. Table 2 summarizes characteristics and main findings of previous meta-analyses and our study.…”

Section: Previous Studiesmentioning

confidence: 98%

“…Recently, several meta-analysis articles have been published comparing VKAs and DOACs in treatment of LVT [17][18][19][20][21][22][23][24]. However, these meta-analyses included only direct comparative studies between VKAs and DOACs, and did not include single-arm studies.…”

Section: Introductionmentioning

confidence: 99%

Therapeutic efficacy of direct oral anticoagulants and vitamin K antagonists for left ventricular thrombus: Systematic review and meta-analysis

et al. 2021

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Background Although several meta-analyses have compared efficacies of vitamin K antagonists (VKAs) and direct oral anticoagulants (DOACs) for treatment of left ventricular thrombus (LVT), those meta-analyses included no single-arm studies. Methods and results PubMed, Scopus, and the Cochrane Library databases were searched for articles investigating thrombus resolution, stroke, any thromboembolism, major bleeding, any bleeding, or all-cause death in LVT treated with VKAs or DOACs, and single-class meta-analyses were also included (PROSPERO database, CRD42021230849). Event rates were pooled using a random effects model. Meta-regression analysis was performed to explore factors that may influence outcomes. 2,612 patients from 23 articles were included (VKAs: 2,004, DOACs: 608). There were no significant differences between VKAs and DOACs in the frequency of thrombus resolution (VKAs: 0.75 [95% confidence interval; 0.67 to 0.81], DOACs: 0.75 [0.67 to 0.82]), stroke (VKAs: 0.06 [0.04 to 0.10], DOACs: 0.02 [0.01 to 0.01]), any thromboembolism (VKAs: 0.08 [0.05 to 0.13], DOACs: 0.03 [0.01 to 0.10]), major bleeding (VKAs: 0.06 [0.04 to 0.09], DOACs: 0.03 [0.01 to 0.06]), any bleeding (VKAs: 0.08 [0.05 to 0.12], DOACs: 0.08 [0.06 to 0.10]), and all-cause death (VKAs: 0.07 [0.04 to 0.13], DOACs: 0.09 [0.05 to 0.16]). Meta-regression analysis revealed that increased duration of follow-up was associated with lower-rates of stroke (estimate: -0.040, p = 0.0495) with VKAs, but not with DOACs. There was significant publication bias for thrombus resolution, stroke, any thromboembolism, any bleeding, and all-cause death. Conclusions Efficacy and adverse outcomes of therapy with DOACs and VKAs do not differ. Randomized controlled trials are needed to determine the optimal anticoagulant strategy.

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“…Many meta-analyses, meta-summaries, and systematic reviews based on these observational studies and case reports have also shown the equivalent efficacy and better safety of DOACs in treating patients with an LV thrombus ( Table 3 ) [ 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 ].…”

Section: Doacs In LV Thrombus—the Clinical Experiencementioning

confidence: 99%

Anticoagulation for Left Ventricle Thrombus—Case Series and Literature Review for Use of Direct Oral Anticoagulants

Pradhan

Bhandari

Vishwakarma

et al. 2023

JCDD

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Left ventricular thrombus is a known complication following acute myocardial infarction that can lead to systemic thromboembolism. To obviate the risk of thromboembolism, the patient needs anticoagulation in addition to dual antiplatelet therapy. However, combining antiplatelets with anticoagulants substantially increases the bleeding risk. Traditionally, vitamin K antagonists (VKAs) have been the sheet anchor for anticoagulation in this scenario. The use of direct oral anticoagulants has significantly attenuated the bleeding risk associated with anticoagulation for atrial fibrillation and venous thromboembolism. Furthermore, in patients with atrial fibrillation undergoing percutaneous coronary intervention, the use of direct oral anticoagulants (DOACs) in conjunction with antiplatelets has been found to be noninferior in reducing ischemic events while significantly attenuating the bleeding compared with VKA. After initial case reports, multiple observational and nonrandomized studies have now safely and effectively utilized direct oral anticoagulants for anticoagulation in left ventricular thrombus. Here, we report a series of two cases presenting with left ventricular thrombus following acute myocardial infarction. In this case series, we try to address the issues concerning the choice and duration of anticoagulation in the case of postinfarct left ventricular thrombus. Pending the results of large randomized control trials, the judicious use of direct oral anticoagulant is warranted when taking into consideration the ischemic and bleeding profile in an individualized approach.

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The Role of Direct Oral Anticoagulants Versus Vitamin K Antagonists in the Treatment of Left Ventricular Thrombi: A Meta-Analysis and Systematic Review

Cited by 11 publications

References 24 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

Therapeutic efficacy of direct oral anticoagulants and vitamin K antagonists for left ventricular thrombus: Systematic review and meta-analysis

Anticoagulation for Left Ventricle Thrombus—Case Series and Literature Review for Use of Direct Oral Anticoagulants

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