Direct Oral Anticoagulants Versus Warfarin in Left Ventricular Thrombus: A Systematic Review and Meta-Analysis

Link to article at PubMed

Am J Ther. 2021 Aug 2. doi: 10.1097/MJT.0000000000001432. Online ahead of print.


BACKGROUND: There are conflicting results regarding the safety and efficacy of direct oral anticoagulants (DOACs) in the management of left ventricular thrombus (LVT) compared with the vitamin K antagonist warfarin.

STUDY QUESTION: What is the safety and efficacy of DOACs in the management of LVT compared with warfarin?

DATA SOURCE: Randomized clinical trials and cohort studies in the MEDLINE and Cochrane databases from inception till April 4, 2021.

STUDY DESIGN: The present analysis is a systematic review and meta-analysis. Desired outcomes were all-cause mortality, complete resolution of LVT, stroke and systemic emboli, and major bleeding. The risk ratio (RR) of the outcomes and 95% confidence intervals (CIs) were calculated using a random-effects modeling approach.

RESULTS: Twelve studies with a total of 2322 patients were included. There was no difference between the 2 interventions in the resolution of LVT [RR 0.97 (CI 0.93-1.02)], stroke and systemic embolism [RR 0.95 (CI 0.63-1.45)], bleeding [RR 1.14 (CI 0.81-1.60)], and all-cause mortality [RR 0.99 (CI 0.67, 1.46)].

CONCLUSIONS: DOACs and warfarin have comparable safety and efficacy outcomes in the management of LVT.

PMID:34387565 | DOI:10.1097/MJT.0000000000001432

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