PDF(Pubmed)
Abstract：
UNASSIGNED: Vitamin K antagonists (VKAs) have been recommended as first-line anticoagulants for patients with left ventricular thrombosis (LVT). Direct oral anticoagulants (DOACs) are used as an alternative to the standard of care in anticoagulation. The aim of this meta-analysis was to compare the efficacy and safety of VKAs and DOACs in the treatment of patients with LVT.
UNASSIGNED: Studies were identified by searching the PubMed, Web of Science, and Embase. The main outcomes included stroke or systemic embolism (SSE), thrombus resolution, and bleeding events. The pooled risk ratio (RR) with 95% confidence intervals (CIs) was estimated with fixed effect or random effect models.
UNASSIGNED: Seventeen studies were included. Pooled estimate showed that DOACs had comparable efficacy in prevention of SSE (RR = 0.96, 95% CI: 0.80, 1.16; p = 0.677) and thrombus resolution as compared with VKAs (RR = 1.07, 95% CI: 0.97, 1.18; p = 0.193). DOACs significantly decreased the risk of stroke in patients with LVT (RR = 0.68, 95% CI: 0.47, 1.00; p = 0.048). However, this effect was not observed in the sensitive analysis by high-quality studies (RR = 0.69, 95% CI: 0.47, 1.02; p = 0.06). In terms of safety outcomes, DOACs had similar risk of bleeding events (RR = 1.12, 95% CI: 0.80, 1.57; p = 0.386) and clinically relevant bleeding events (RR = 0.49, 95% CI: 0.23, 1.03; p = 0.060). Meta-regression analysis demonstrated that none of the variables (study design, concomitant antiplatelet medication, duration of follow-up, primary cause of LVT, sample size, types of DOACs) had an impact on the risk of SSE, thrombus resolution and bleeding events. Subgroup analysis based on the use of antiplatelet and treatment switching revealed that there were no significant differences among patients with different treatment regimens.
UNASSIGNED: Based on the present evidence, both DOACs and VKA offered similar effective and safe outcomes in patients with LVT.
UNASSIGNED: Studies were identified by searching the PubMed, Web of Science, and Embase. The main outcomes included stroke or systemic embolism (SSE), thrombus resolution, and bleeding events. The pooled risk ratio (RR) with 95% confidence intervals (CIs) was estimated with fixed effect or random effect models.
UNASSIGNED: Seventeen studies were included. Pooled estimate showed that DOACs had comparable efficacy in prevention of SSE (RR = 0.96, 95% CI: 0.80, 1.16; p = 0.677) and thrombus resolution as compared with VKAs (RR = 1.07, 95% CI: 0.97, 1.18; p = 0.193). DOACs significantly decreased the risk of stroke in patients with LVT (RR = 0.68, 95% CI: 0.47, 1.00; p = 0.048). However, this effect was not observed in the sensitive analysis by high-quality studies (RR = 0.69, 95% CI: 0.47, 1.02; p = 0.06). In terms of safety outcomes, DOACs had similar risk of bleeding events (RR = 1.12, 95% CI: 0.80, 1.57; p = 0.386) and clinically relevant bleeding events (RR = 0.49, 95% CI: 0.23, 1.03; p = 0.060). Meta-regression analysis demonstrated that none of the variables (study design, concomitant antiplatelet medication, duration of follow-up, primary cause of LVT, sample size, types of DOACs) had an impact on the risk of SSE, thrombus resolution and bleeding events. Subgroup analysis based on the use of antiplatelet and treatment switching revealed that there were no significant differences among patients with different treatment regimens.
UNASSIGNED: Based on the present evidence, both DOACs and VKA offered similar effective and safe outcomes in patients with LVT.
摘要：
■维生素K拮抗剂（VKAs）已被推荐为左心室血栓形成（LVT）患者的一线抗凝剂。直接口服抗凝剂（DOAC）被用作抗凝护理标准的替代品。这项荟萃分析的目的是比较VKAs和DOAC治疗LVT患者的疗效和安全性。
■通过搜索PubMed，WebofScience,和Embase。主要结局包括卒中或全身性栓塞（SSE），血栓分辨率,出血事件。使用固定效应或随机效应模型估计具有95％置信区间（CI）的合并风险比（RR）。
■纳入了17项研究。汇总估计显示，与VKAs（RR=1.07，95％CI：0.97，1.18；p=0.193）相比，DOAC在预防SSE（RR=0.96，95％CI：0.80，1.16；p=0.677）和血栓分辨率方面具有相当的功效。DOAC显著降低LVT患者卒中风险(RR=0.68,95%CI:0.47,1.00;p=0.048)。然而,在高质量研究的敏感分析中未观察到这种效应(RR=0.69,95%CI:0.47,1.02;p=0.06).就安全结果而言，DOACs具有相似的出血事件风险(RR=1.12,95%CI:0.80,1.57;p=0.386)和临床相关出血事件风险(RR=0.49,95%CI:0.23,1.03;p=0.060)。荟萃回归分析表明，没有变量(研究设计，伴随抗血小板药物，随访时间，LVT的主要原因,样本量,DOAC的类型)对SSE的风险有影响，血栓消退和出血事件。基于抗血小板使用和治疗转换的亚组分析显示，不同治疗方案的患者之间没有显着差异。
■根据目前的证据，DOAC和VKA在LVT患者中提供了相似的有效和安全结局.
■通过搜索PubMed，WebofScience,和Embase。主要结局包括卒中或全身性栓塞（SSE），血栓分辨率,出血事件。使用固定效应或随机效应模型估计具有95％置信区间（CI）的合并风险比（RR）。
■纳入了17项研究。汇总估计显示，与VKAs（RR=1.07，95％CI：0.97，1.18；p=0.193）相比，DOAC在预防SSE（RR=0.96，95％CI：0.80，1.16；p=0.677）和血栓分辨率方面具有相当的功效。DOAC显著降低LVT患者卒中风险(RR=0.68,95%CI:0.47,1.00;p=0.048)。然而,在高质量研究的敏感分析中未观察到这种效应(RR=0.69,95%CI:0.47,1.02;p=0.06).就安全结果而言，DOACs具有相似的出血事件风险(RR=1.12,95%CI:0.80,1.57;p=0.386)和临床相关出血事件风险(RR=0.49,95%CI:0.23,1.03;p=0.060)。荟萃回归分析表明，没有变量(研究设计，伴随抗血小板药物，随访时间，LVT的主要原因,样本量,DOAC的类型)对SSE的风险有影响，血栓消退和出血事件。基于抗血小板使用和治疗转换的亚组分析显示，不同治疗方案的患者之间没有显着差异。
■根据目前的证据，DOAC和VKA在LVT患者中提供了相似的有效和安全结局.
