Abstract：
Direct oral anticoagulants (DOACs) are the guideline-recommended therapy for some hypercoagulable diseases but are used off-label for left ventricular thrombus (LVT) owing to a paucity of evidence. We performed a meta-analysis to assess the safety and efficacy of DOACs compared with vitamin K antagonists (VKAs) for LVT treatment.
We comprehensively searched PubMed, EMBASE, Cochrane Library, and Web of Science databases for studies that compared DOACs with VKAs for LVT treatment. Outcome indicators included stroke or systemic embolism (SSE), thrombus resolution, bleeding, and death. The Newcastle-Ottawa scale was used to evaluate the quality of included studies. Data were analyzed using Review Manager 5.3, and the meta-analysis is registered at PROSPERO (CRD 42020211376).
We included 12 observational studies (n = 2262 patients). SSE was similar for DOACs and VKAs groups (odds ratio (OR) = 1.01, 95% confidence interval (CI) 0.66-1.54, P = 0.95). For thrombus resolution, DOACs were not significantly different to VKAs (OR = 1.15, 95% CI 0.54-2.45, P = 0.71). DOACs and VKAs had a similar bleeding risk (OR = 0.78, 95% CI 0.45-1.35, P = 0.37). DOACs and VKAs groups had a comparable mortality (OR = 0.91, 95% CI 0.50-1.65, P = 0.76). Subgroup analysis showed that post-acute myocardial infarction (AMI) patients using DOACs had a lower risk of SSE (OR = 0.24, 95% CI 0.07-0.87, P = 0.03) and bleeding (OR = 0.38, 95% CI 0.18-0.81, P = 0.01).
DOACs and VKAs showed no difference in the safety and efficacy of patients with LVT. DOACs might be superior to VKAs for LVT treatment in post-AMI patients.
We comprehensively searched PubMed, EMBASE, Cochrane Library, and Web of Science databases for studies that compared DOACs with VKAs for LVT treatment. Outcome indicators included stroke or systemic embolism (SSE), thrombus resolution, bleeding, and death. The Newcastle-Ottawa scale was used to evaluate the quality of included studies. Data were analyzed using Review Manager 5.3, and the meta-analysis is registered at PROSPERO (CRD 42020211376).
We included 12 observational studies (n = 2262 patients). SSE was similar for DOACs and VKAs groups (odds ratio (OR) = 1.01, 95% confidence interval (CI) 0.66-1.54, P = 0.95). For thrombus resolution, DOACs were not significantly different to VKAs (OR = 1.15, 95% CI 0.54-2.45, P = 0.71). DOACs and VKAs had a similar bleeding risk (OR = 0.78, 95% CI 0.45-1.35, P = 0.37). DOACs and VKAs groups had a comparable mortality (OR = 0.91, 95% CI 0.50-1.65, P = 0.76). Subgroup analysis showed that post-acute myocardial infarction (AMI) patients using DOACs had a lower risk of SSE (OR = 0.24, 95% CI 0.07-0.87, P = 0.03) and bleeding (OR = 0.38, 95% CI 0.18-0.81, P = 0.01).
DOACs and VKAs showed no difference in the safety and efficacy of patients with LVT. DOACs might be superior to VKAs for LVT treatment in post-AMI patients.
摘要：
直接口服抗凝剂（DOAC）是某些高凝疾病的指南推荐疗法，但由于证据不足，已用于左心室血栓（LVT）。我们进行了一项荟萃分析，以评估DOAC与维生素K拮抗剂（VKAs）治疗LVT的安全性和有效性。
我们全面搜索了PubMed,EMBASE,科克伦图书馆,和WebofScience数据库用于比较DOAC和VKAs治疗LVT的研究。结果指标包括卒中或全身性栓塞（SSE），血栓分辨率,出血,和死亡。采用纽卡斯尔-渥太华量表评价纳入研究的质量。使用ReviewManager5.3分析数据，荟萃分析在PROSPERO（CRD42020211376）注册。
我们纳入了12项观察性研究（n=2262名患者）。DOAC和VKAs组的SSE相似（比值比（OR）=1.01，95％置信区间（CI）0.66-1.54，P=0.95）。为了解决血栓，DOAC与VKAs无显著差异(OR=1.15,95%CI0.54~2.45,P=0.71)。DOACs和VKAs具有相似的出血风险(OR=0.78,95%CI0.45-1.35,P=0.37)。DOACs组和VKAs组的死亡率相当(OR=0.91,95%CI0.50-1.65,P=0.76)。亚组分析显示，使用DOAC的急性心肌梗死（AMI）患者发生SSE（OR=0.24，95％CI0.07-0.87，P=0.03）和出血（OR=0.38，95％CI0.18-0.81，P=0.01）的风险较低。
DOAC和VKAs在LVT患者的安全性和有效性方面没有差异。在AMI后患者的LVT治疗中，DOAC可能优于VKAs。
我们全面搜索了PubMed,EMBASE,科克伦图书馆,和WebofScience数据库用于比较DOAC和VKAs治疗LVT的研究。结果指标包括卒中或全身性栓塞（SSE），血栓分辨率,出血,和死亡。采用纽卡斯尔-渥太华量表评价纳入研究的质量。使用ReviewManager5.3分析数据，荟萃分析在PROSPERO（CRD42020211376）注册。
我们纳入了12项观察性研究（n=2262名患者）。DOAC和VKAs组的SSE相似（比值比（OR）=1.01，95％置信区间（CI）0.66-1.54，P=0.95）。为了解决血栓，DOAC与VKAs无显著差异(OR=1.15,95%CI0.54~2.45,P=0.71)。DOACs和VKAs具有相似的出血风险(OR=0.78,95%CI0.45-1.35,P=0.37)。DOACs组和VKAs组的死亡率相当(OR=0.91,95%CI0.50-1.65,P=0.76)。亚组分析显示，使用DOAC的急性心肌梗死（AMI）患者发生SSE（OR=0.24，95％CI0.07-0.87，P=0.03）和出血（OR=0.38，95％CI0.18-0.81，P=0.01）的风险较低。
DOAC和VKAs在LVT患者的安全性和有效性方面没有差异。在AMI后患者的LVT治疗中，DOAC可能优于VKAs。
