Oral anticoagulation in patients with left ventricular thrombus: a systematic review and meta-analysis.
Eur Heart J Cardiovasc Pharmacother
; 10(5): 444-453, 2024 Aug 14.
Article
em En
| MEDLINE
| ID: mdl-38845369
ABSTRACT
AIMS:
Direct oral anticoagulants (DOACs) are increasingly used off-label to treat patients with left ventricular thrombus (LVT). We analysed available meta-data comparing DOACs and vitamin K antagonists (VKAs) for efficacy and safety.METHODS:
We conducted a systematic search and meta-analysis of observational and randomized data comparing DOACs vs. 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-effects model meta-analysis, and their robustness was investigated using sensitivity and influential analyses.RESULTS:
We identified 22 articles (18 observational studies, 4 small randomized clinical trials) reporting on a total of 3587 patients (2489 VKA vs. 1098 DOAC therapy). The pooled estimates for stroke or systemic embolism [odds ratio (OR) 0.81; 95% confidence interval (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. The use of DOACs 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.CONCLUSION:
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 with 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.Palavras-chave
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Base de dados:
MEDLINE
Assunto principal:
Trombose
/
Cardiopatias
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Hemorragia
Idioma:
En
Ano de publicação:
2024
Tipo de documento:
Article