Warfarin vs non‐vitamin K oral anticoagulants for left atrial appendage thrombus: A meta‐analysis

Abstract

Introduction Novel oral anticoagulants (NOACs) are commonly used for thromboembolic risk reduction and treatment of pulmonary embolism and deep venous thrombosis. However, data regarding their efficacy and safety in comparison to warfarin for left atrial appendage thrombus is limited. Methods A comprehensive literature search in PubMed, Google Scholar, and Cochrane Review from inception to 30 October 2019 was performed. Studies reporting clinical outcomes comparing warfarin vs NOACs were included. Two investigators independently extracted the data and individual quality assessment was performed. A meta‐analysis was performed using random‐effects model to calculate risk ratio (RR) and 95% confidence interval (CI). The analysis was performed using RevMan 5.3. Results Four studies met inclusion criteria and a total of 322 patients were included of whom 141 were in the NOAC arm and 181 were in the warfarin arm. There was no significant difference in thrombus resolution between the two groups (RR, 1.00; 95% CI [0.77‐1.29; P = .98]). There was no significant difference in major bleeding (RR, 1.30; 95% CI [0.14‐12.21; P = .82]) or stroke (RR, 0.42; 95% CI [0.09‐2.06; P = .29]) between the two groups. Conclusion The results of our meta‐analysis show that NOACs are as efficacious and safe as warfarin in the treatment of left atrial appendage thrombus in patients with non‐valvular atrial fibrillation.

Direct oral anticoagulants to treat left ventricular thrombus—A systematic review and meta‐analysis: ELECTRAM investigators

“…Furthermore, no significant difference was observed in terms of SEE and failure of LV thrombus resolution in patients treated with DOACs compared to VKAs. Similar results have also been demonstrated in patients with other forms of cardiac thrombus like left atrial appendage thrombus 29 . With a growing body of evidence and increasing interest in DOACs utilization, our study results are vital in demonstrating the safety and efficacy of DOACs in patients with LV thrombus.…”

“…The significantly lower odds of overall bleeding with DOAC's (compared to VKA's) observed in our study could have been primarily driven by reduced rates of minor bleeding events (and numerical lower major bleeding events rates with DOAC's—finding that did not reach statistical significance). Furthermore, the pooled incidence of overall bleeding and major bleeding were 5.6% and 1.1% with DOACs, respectively; findings significantly lower to patients with LAA thrombus in a prior study (overall bleeding: 12.1%; major bleeding: 0.7%) 29 …”

“…Similar results have also been demonstrated in patients with other forms of cardiac thrombus like left atrial appendage thrombus. 29 With a growing body of evidence and increasing interest in DOACs utilization, our study results are vital in demonstrating the safety and efficacy of DOACs in patients with LV thrombus.…”

“…Furthermore, the pooled incidence of overall bleeding and major bleeding were 5.6% and 1.1% with DOACs, respectively; findings significantly lower to patients with LAA thrombus in a prior study (overall bleeding: 12.1%; major bleeding: 0.7%). 29 As MI is a major precipitating factor for LV thrombus, evaluating the bleeding risk in the background of antiplatelet therapy in LV thrombus patients is essential. In patients with AF who are on P2Y12 inhibitors or DAPT for CAD, several clinical trials, [31][32][33] observational studies 34 and pooled analysis 35 have demonstrated a significantly lower risk of bleeding with DOACs, compared to warfarin.…”

The Safety and Efficacy of Standard-Dose versus Low-Dose Non-Vitamin K Antagonist Oral Anticoagulants in Patients with Nonvalvular Atrial Fibrillation and Left Atrial Appendage Thrombus

“…Finally, thrombus resolution was achieved in 83.3% and 81.8% of patients treated with dabigatran and rivaroxaban, respectively. Some other studies also confirmed the efficacy of NOACs in the treatment of LAAT [16][17][18]. However, standard-dose NOACs were commonly used in those investigations.…”