Use of Direct Oral Anticoagulants in the Treatment of Left Ventricular Thrombi: A Systematic Review

Sedhom, Ramy; Abdelmaseeh, Peter; Megaly, Michael; Asinger, Richard R.W.

doi:10.1016/j.amjmed.2020.05.012

Cited by 19 publications

(24 citation statements)

References 50 publications

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“…Dabigatran, a direct thrombin inhibitor, reversibly inhibits both free and brin-bound thrombin resulting in inhibition of thrombin-mediated platelet aggregation.. [36] In the recent years, off-label use of DOACs for the treatment of LVT has popularized among both physicians and patients owing to their ease of administration, lack of dietary restrictions, and freedom from regular blood draws. [10,11] Moreover, multiple studies like RE-LY, ARISTOTLE, ROCKET-AF over the course of years have shown superiority or either non-inferiority of DOACs in patients with atrial brillation in preventing SSE with better bleeding pro le. [37][38][39] Similarly, there is strong evidence supporting DOACs having similar or better e cacy than warfarin in deep venous thrombus resolution with less bleeding complications.…”

Section: Discussionmentioning

confidence: 99%

“…A recent systematic review of use of DOACs in the treatment of LVT included 53 articles and concluded that routine use of DOACs cannot be recommended based on their con icting results. [11] However, it comprised largely of individual cases of LVT without quantitatively comparing the DOACs and warfarin.…”

Section: Discussionmentioning

confidence: 99%

“…[7] Although the current guidelines suggest that the choice of anticoagulation therapy to be used for LVT is a vitamin-K antagonist such as warfarin [8,9], off-label use of direct oral anticoagulants (DOACs) is becoming popular among both patient and physicians. [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.…”

Section: Introductionmentioning

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: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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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“…However, 2020 Sedhom et al [30] published a systematic review which collected studies of direct oral anticoagulants for treatment of left ventricular thrombus from January 1st, 2009 till April 25th. Among the 85 patients who were included in the case reports and case series, seventy-four patients (87%) were prescribed a NOAC and had follow-up imaging which showed complete resolution in 69 patients (93.2%).…”

Section: Discussionmentioning

confidence: 99%

Effectiveness and Safety of Non-Vitamin K Antagonist Oral Anticoagulants Compared to Vitamin K Antagonists for the Treatment of Ventricular Thrombus: A Systematic Review and Meta-analysis of Observational Studies

Yang

Liang

2020

Preprint

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Background To compare the effectiveness and safety of non-vitamin K antagonist oral anticoagulants (NOACs) and vitamin K antagonists (VKAs) on the rate of thrombus resolution and clinical outcomes.Method MEDLINE, PUBMED, EMBASE, Cochrane Library, Web of Science, China National Knowledge Infrastructure Database and Wanfang Database, were searched up to August 16, 2020. Observational studies of patients with ventricular thrombus which compared the effect of two agents on the primary outcome were included. The primary outcome was rate of thrombus resolution, and the secondary outcomes were systemic embolism, bleeding and all-cause death. Odds ratio (OR) and 95% confidential intervals (CI) were utilized for the pooled results.Result Eight studies with 905 participants were finally included. Among these cases, 66.6% of patients received VKAs and 33.4% of patients received NOACs. Rivaroxaban (71.9%) was the most commonly used NOACs. There were no significant differences between NOACs and VKAs groups in thrombus resolution (OR 1.18, 95% CI 0.73-1.91), systemic embolism (OR 0.83, 95% CI 0.34-2.05), bleeding (OR 0.65, 95% CI 0.35-1.19) and all-cause death (OR 0.95, 95% CI 0.53-1.71). In studies with rivaroxaban predominantly or only rivaroxaban in the NOACs groups, NOACs group showed high thrombus resolution rate (OR 2.31, 95% CI 1.31-4.07) and lower systemic embolism rate (OR 0.32, 95% CI 0.11-0.96) than VKAs group, but no differences in bleeding.Conclusion Our findings showed that NOACs had a comparative complete resolution of thrombus compared with VKAs, as well as systemic embolism, bleeding events and all-cause death. In subgroups with rivaroxaban predominantly or only rivaroxaban in the NOACs group, NOACs showed better efficacy and safety profiles than VKAs, indicating that rivaroxaban might have favorable effectiveness over VKAs, though the sample size of NOACs in ventricular thrombus is small and the studies are most non-randomized. Further randomized controlled trials are urgently required to assess the effectiveness and safety of NOACs in patients with ventricular thrombus.

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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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Use of Direct Oral Anticoagulants in the Treatment of Left Ventricular Thrombi: A Systematic Review

Cited by 19 publications

References 50 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

Effectiveness and Safety of Non-Vitamin K Antagonist Oral Anticoagulants Compared to Vitamin K Antagonists for the Treatment of Ventricular Thrombus: A Systematic Review and Meta-analysis of Observational Studies

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

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