Meta-Analysis Comparing Direct Oral Anticoagulants to Vitamin K Antagonists for The Management of Left Ventricular Thrombus. (4th May 2021)

• Record Type: Journal Article
• Authors: Abdelaziz, Hesham K.; Megaly, Michael; Debski, Maciej; Abdelrahman, Amr; Abdelaziz, Shehab; Kamal, Diaa; Patel, Billal; More, Ranjit; Choudhury, Tawfiq
• Is Part Of: Expert review of cardiovascular therapy. Volume 19:Number 5(2021)
• Page Start: 427
• Page End: 432
• Publication Date: 2021-05-04
• Subjects: Left ventricular thrombus -- direct oral anticoagulants -- vitamin K antagonist -- stroke -- systemic embolism; Cardiovascular agents -- Research -- Periodicals; 616.12061
• DOI: 10.1080/14779072.2021.1915134
• Languages: English
• ISSNs: 1477-9072

Abstract

ABSTRACT: Introduction : To compare vitamin K antagonists (VKAs) and direct oral anticoagulants (DOACs) treatment in patients with left ventricular (LV) thrombus. The primary outcome was stroke or systemic embolism (SSE). Secondary outcomes were thrombus resolution, bleeding, and death. Areas covered : Five observational studies were included (total n = 700; VKAs n = 480; DOACs n = 220). There was a trend toward less SSE with VKAs compared to DOACs (5.2% vs. 9%; odds ratio [OR] = 0.54, 95% confidence interval [CI] = 0.29–1.01, p = 0.05). No significant difference between VKAs and DOACs in rates of thrombus resolution (61.6% vs. 56.8%; OR = 1.00, 95% CI = 0.58–1.73, p = 0.99), bleeding (8.2% vs. 4.4%; OR = 1.62, 95% CI = 0.69–3.77, p = 0.27), or death (12.7% vs. 11.8%; OR = 1.09, 95% CI = 0.59–2.0, p = 0.79) was noted. In non-primary percutaneous coronary intervention setting, VKAs were associated with less SSE in prespecified analysis (5.2% vs.10.6%; OR = 0.48, 95% CI = 0.25–0.93, p = 0.03). Expert opinion : The current meta-analysis suggests a trend toward higher SSE with the use of DOACs compared to VKAs. Our recommendation is for VKAs to retain the preferred management of LV thrombus with cautious off-label use of DOACs.