{Reference Type}: Journal Article
{Title}: Oral anticoagulation in patients with left ventricular thrombus - a systematic review and meta-analysis.
{Author}: Haller PM;Kazem N;Agewall S;Borghi C;Ceconi C;Dobrev D;Cerbai E;Grove EL;Kaski JC;Lewis BS;Niessner A;Rocca B;Rosano G;Savarese G;Schnabel R;Semb AG;Sossalla S;Wassmann S;Sulzgruber P;
{Journal}: Eur Heart J Cardiovasc Pharmacother
{Volume}: 0
{Issue}: 0
{Year}: 2024 Jun 6
暂无{DOI}: 10.1093/ehjcvp/pvae042
{Abstract}: <B>OBJECTIVE: </B>Direct oral anticoagulants (DOACs) are increasingly used off-label to treat patients with left ventricular thrombus (LVT). We analyzed available meta-data comparing DOACs and vitamin K antagonists (VKAs) for efficacy and safety.<BR><B>METHODS: </B>We conducted a systematic search and meta-analysis of observational and randomized data comparing DOACs versus VKAs in patients with LVT. Endpoints of interest were stroke or systemic embolism, thrombus resolution, all-cause death, and a composite bleeding endpoint. Estimates were pooled using a random-effect model meta-analysis, and their robustness was investigated using sensitivity and influential analyses.<BR><B>RESULTS: </B>We identified 22 articles (18 observational studies, 4 small randomized clinical trials) reporting on a total of 3,587 patients (2,489 VKA vs. 1,098 DOAC therapy). The pooled estimates for stroke or systemic embolism (OR 0.81; 95% CI [0.57, 1.15]) and thrombus resolution (OR 1.12; 95% CI [0.86; 1.46]) were comparable, and there was low heterogeneity overall across the included studies. DOAC use was associated with lower odds of all-cause death (OR 0.65; 95%CI [0.46; 0.92]) and a composite bleeding endpoint (OR 0.67; 95%CI [0.47; 0.97]). A risk of bias was evident particularly for observational reports, with some publication bias suggested in funnel plots.<BR><B>CONCLUSIONS: </B>In this comprehensive analysis of mainly observational data, the use of DOACs was not associated with a significant difference in stroke or systemic embolism, or thrombus resolution compared to VKA therapy. The use of DOACs was associated with a lower rate of all-cause death and fewer bleeding events. Adequately sized randomized clinical trials are needed to confirm these findings, which could allow a wider adoption of DOACs in patients with LVT.