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Warfarin versus direct oral anticoagulants for treating left ventricular thrombus: a systematic review and

Tarun Dalia1, Shubham Lahan2, Sagar Ranka1

  • 1Department of Cardiovascular Medicine, The University of Kansas Medical Center, Kansas City, Kansas, USA.

Thrombosis Journal
|February 1, 2021
PubMed

Insights

Direct oral anticoagulants (DOACs) are as effective as warfarin for treating left ventricular thrombus (LVT). This meta-analysis found no significant differences in thrombus resolution, stroke, or bleeding events between DOACs and warfarin.

Area of Science:

  • Cardiology
  • Pharmacology
  • Clinical Medicine

Background:

  • Left ventricular thrombus (LVT) poses a risk of systemic embolism, necessitating effective anticoagulation.
  • Direct oral anticoagulants (DOACs) are emerging as alternatives to warfarin, but their comparative efficacy and safety for LVT require evaluation.

Purpose of the Study:

  • To compare the therapeutic efficacy and safety of DOACs versus warfarin in the treatment of left ventricular thrombus.
  • To synthesize existing evidence through a meta-analysis to inform clinical practice.

Main Methods:

  • Systematic literature search of PubMed/Medline, Google Scholar, Cochrane library, and LILCAS databases up to August 14, 2020.
  • Meta-analysis of pooled data from 8 studies involving 1955 patients comparing warfarin and DOACs for LVT treatment.

Main Results:

  • No statistically significant difference in thrombus resolution between warfarin and DOACs (OR 1.11, p=0.76).
  • Similar rates of stroke or systemic embolization (RR 1.04, p=0.85) and bleeding complications (RR 1.15, p=0.57) were observed.
  • Overall mortality showed no significant difference between the two treatment groups (RR 1.09, p=0.48).

Conclusions:

  • DOACs are non-inferior and demonstrate comparable effectiveness to warfarin in treating left ventricular thrombus.
  • DOACs offer a safe alternative to warfarin, with no statistically significant increase in stroke, systemic embolism, or bleeding complications.
Abstract

Keywords:
AnticoagulationDOAC/NOACLeft ventricular thrombusRelative riskWarfarin

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