PDF(Pubmed)
Abstract：
BACKGROUND: Literature on the preferred anticoagulant for treating left ventricular thrombus (LVT) is lacking. Thus, our objective was to compare the efficacy of DOACs versus warfarin in treating LVT.
METHODS: Databases were searched for RCTs and adjusted observational studies that compared DOAC versus warfarin through March 2024. The primary efficacy outcomes of interest were LVT resolution, systemic embolism, composite of stroke, and TIA. The primary safety outcomes encompassed all-cause mortality and bleeding events.
RESULTS: Our meta-analysis including 31 studies demonstrated that DOAC use was associated with higher odds of thrombus resolution (OR: 1.08, 95% CI: 0.86-1.31, p: 0.46). A statistically significant reduction in the risk of stroke/TIA was observed in the DOAC group versus the warfarin group (OR: 0.65, 95% CI: 0.48-0.89, p: 0.007). Furthermore, statistically significant reduced risks of all-cause mortality (OR: 0.68, 95% CI: 0.47-0.98, p: 0.04) and bleeding events (OR: 0.70, 95% CI: 0.55-0.89, p: 0.004) were observed with DOAC use as compared to warfarin use.
CONCLUSIONS: Compared to VKAs, DOACs are noninferior as the anticoagulant of choice for LVT treatment. However, further studies are warranted to confirm these findings.
METHODS: Databases were searched for RCTs and adjusted observational studies that compared DOAC versus warfarin through March 2024. The primary efficacy outcomes of interest were LVT resolution, systemic embolism, composite of stroke, and TIA. The primary safety outcomes encompassed all-cause mortality and bleeding events.
RESULTS: Our meta-analysis including 31 studies demonstrated that DOAC use was associated with higher odds of thrombus resolution (OR: 1.08, 95% CI: 0.86-1.31, p: 0.46). A statistically significant reduction in the risk of stroke/TIA was observed in the DOAC group versus the warfarin group (OR: 0.65, 95% CI: 0.48-0.89, p: 0.007). Furthermore, statistically significant reduced risks of all-cause mortality (OR: 0.68, 95% CI: 0.47-0.98, p: 0.04) and bleeding events (OR: 0.70, 95% CI: 0.55-0.89, p: 0.004) were observed with DOAC use as compared to warfarin use.
CONCLUSIONS: Compared to VKAs, DOACs are noninferior as the anticoagulant of choice for LVT treatment. However, further studies are warranted to confirm these findings.
摘要：
背景：缺乏关于治疗左心室血栓（LVT）的首选抗凝剂的文献。因此，我们的目的是比较DOACs与华法林治疗LVT的疗效.
方法：在2024年3月之前搜索RCT并调整观察性研究，比较DOAC和华法林。感兴趣的主要疗效结果是LVT消退，全身性栓塞,合成的行程，和TIA。主要安全性结果包括全因死亡率和出血事件。
结果：我们的荟萃分析包括31项研究表明，使用DOAC与血栓消退的几率更高相关(OR:1.08,95%CI:0.86-1.31,p:0.46)。与华法林组相比，DOAC组观察到卒中/TIA风险的统计学显着降低（OR：0.65，95％CI：0.48-0.89，p：0.007）。此外，与使用华法林相比,使用DOAC可观察到全因死亡率(OR:0.68,95%CI:0.47~0.98,p:0.04)和出血事件(OR:0.70,95%CI:0.55~0.89,p:0.004)的风险显著降低.
结论：与VKAs相比，DOAC作为LVT治疗的首选抗凝剂并不逊色。然而,需要进一步的研究来证实这些发现.
方法：在2024年3月之前搜索RCT并调整观察性研究，比较DOAC和华法林。感兴趣的主要疗效结果是LVT消退，全身性栓塞,合成的行程，和TIA。主要安全性结果包括全因死亡率和出血事件。
结果：我们的荟萃分析包括31项研究表明，使用DOAC与血栓消退的几率更高相关(OR:1.08,95%CI:0.86-1.31,p:0.46)。与华法林组相比，DOAC组观察到卒中/TIA风险的统计学显着降低（OR：0.65，95％CI：0.48-0.89，p：0.007）。此外，与使用华法林相比,使用DOAC可观察到全因死亡率(OR:0.68,95%CI:0.47~0.98,p:0.04)和出血事件(OR:0.70,95%CI:0.55~0.89,p:0.004)的风险显著降低.
结论：与VKAs相比，DOAC作为LVT治疗的首选抗凝剂并不逊色。然而,需要进一步的研究来证实这些发现.
