Treatment of Left Ventricular Thrombus With Direct Oral Anticoagulants: A Retrospective Observational Study

Guddeti, Raviteja; Anwar, Muhammad; Walters, Ryan W.; Apala, Dinesh Reddy; Pajjuru, Venkata Siva Kumar; Kousa, Omar; Gujjula, Nagarjuna; Alla, Venkata

doi:10.1016/j.amjmed.2020.05.025

Cited by 67 publications

(143 citation statements)

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“…Ten studies reported the occurrence of SSE [5][6][7][8][9][20][21][22][23][24][25] . The NOACs group and VKAs group did not show a significant difference in the risk of SSE (RR:0.96, 95% CI: 0.80-1.16, P = 0.69; I 2 = 0%, figure 3A).…”

Section: Stroke and Embolic Eventsmentioning

confidence: 99%

“…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%

“…Current guidelines recommend vitamin K antagonists (VKAs) for LVT patients based on limited evidence from observational studies [1][2][3][4] . However, off-label use of novel oral anticoagulants (NOACs) for LVT is gaining interest, as they provide more constant anticoagulant effects and do not require continuous monitor of international normalized ratio (INR) 1,[5][6][7][8][9] . Numerous trials and analysis have already proved NOACs acquire similar efficacy in SSE prevention and lower bleeding risk in other clinical scenarios (e.g.…”

mentioning

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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Section: Stroke and Embolic Eventsmentioning

confidence: 99%

Section: Stroke and Embolic Eventsmentioning

confidence: 99%

Section: Thrombus Resolutionmentioning

confidence: 99%

Section: Bleeding Eventsmentioning

confidence: 99%

mentioning

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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Assessment of non‐vitamin K antagonist oral anticoagulants for the management of left ventricular thrombus

Deng

Tong

et al. 2021

Clinical Cardiology

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Although several studies have assessed the effect of non‐vitamin K antagonist oral anticoagulants (NOACs) relative to that of vitamin K antagonists (VKAs) in patients with left ventricular thrombus, the results remain controversial. Herein, a meta‐analysis was performed to compare the effectiveness and safety of NOACs versus VKAs for the treatment of left ventricular thrombus. We systematically searched the Cochrane Library, PubMed and Embase databases until November 2020 for studies that compared the effects of NOACs versus VKAs in patients with left ventricular thrombus. The treatment effects were expressed as odds ratios (ORs) with 95% confidence intervals (CIs) and pooled by a random‐effects model. Seven retrospective studies involving 865 patients with left ventricular thrombus (266 NOAC and 599 VKA users) were included. The pooled analysis suggested no difference in the rate of thrombus resolution between the NOAC and VKA groups (OR = 0.83, 95% CI 0.61–1.13). There were also no differences in the rates of stroke or systemic embolism (OR = 0.62, 95% CI 0.20–1.97), bleeding events (OR = 0.73, 95% CI 0.37–1.45), or all‐cause death (OR = 0.92, 95% CI 0.50–1.69) between patients treated with NOACs and those treated with VKAs. In addition, the rates of thrombus resolution, stroke or systemic embolism, bleeding events, and all‐cause death between NOAC‐ and warfarin‐treated patients were also similar. Our current evidence suggested that NOAC and VKA users had similar rates of thrombus resolution and clinical outcomes among patients with left ventricular thrombus. Further large‐scale prospective studies should confirm our results.

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

2022

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Aims Left ventricular thrombus (LVT) increases the risk of thrombotic events and mortality. Vitamin K antagonists (VKAs) used to treat LVT have several known risks, as a result of which direct oral anticoagulant (DOAC) use has recently increased. We aimed to evaluate the safety and efficacy of DOACs and VKAs in treating LVT. Methods and results We searched PubMed, Embase, Cochrane Library trials, and Web of Science databases for studies published before 19 April 2022, involving DOAC versus VKA treatment for patients with LVT. This meta‐analysis comprised 21 studies (total patients, n = 3172; DOAC group, n = 888; VKA group, n = 2284). A statistically significant reduction in bleeding events was observed in patients on DOACs vs. those on VKAs (risk ratio (RR) = 0.73, P = 0.004). Patients on DOACs residing in North American and European regions and those with ischaemic heart disease (IHD) had a significantly lower risk of bleeding events than patients residing in other regions or those with a different LVT aetiology, respectively (RR = 0.78, P = 0.04; RR = 0.38, P = 0.02; and RR = 0.63, P = 0.009). A statistically significant reduction in stroke in patients on DOACs versus VKAs (RR = 0.72, P = 0.03) was observed, and patients on DOACs residing in North America and those with IHD had a significantly lower risk of stroke (RR = 0.73, P = 0.04, and RR = 0.61, P = 0.03, respectively). Compared with VKAs, DOACs are statistically associated with an increase in LVT resolution at 1 month (RR = 1.96, P = 0.008). No statistical between‐group difference in all‐cause mortality (RR = 0.72, P = 0.05), systemic embolism (RR = 0.87, P = 0.74), stroke or systemic embolism (RR = 0.90, P = 0.50), and LVT resolution at the end of follow‐up (RR = 1.06, P = 0.13) was observed. Conclusions Compared with VKAs, DOACs significantly reduce the risk of bleeding events and stroke in LVT patients, but mortality was similar in both groups. The advantages are apparent not only in patients belonging to the predominantly white residential areas such as North American and European regions but also in patients with LVT due to IHD. DOACs show promising effects in treating LVT compared with VKAs.

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Treatment of Left Ventricular Thrombus With Direct Oral Anticoagulants: A Retrospective Observational Study

Cited by 67 publications

References 7 publications

Novel Oral Anticoagulants versus Vitamin K Antagonists for Patients with 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

Assessment of non‐vitamin K antagonist oral anticoagulants for the management of left ventricular thrombus

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

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