Meta-analysis comparing direct oral anticoagulants versus vitamin K antagonists in patients with left ventricular...

Area of Science:

• Cardiology
• Pharmacology
• Clinical Medicine

Background:

• Current guidelines recommend vitamin K antagonists (VKAs) for anticoagulation in left ventricular thrombus (LVT).
• Direct oral anticoagulants (DOACs) are emerging alternatives, but comparative data for LVT is limited and conflicting.

Purpose of the Study:

• To conduct a meta-analysis comparing the efficacy and safety of DOACs versus VKAs in patients with LVT.
• To aggregate existing studies to provide a clearer comparison of treatment outcomes.

Main Methods:

• Systematic literature search of Cochrane Library, Google Scholar, MEDLINE, and Web of Science up to January 10, 2021.
• Inclusion of eight studies for stroke or systemic embolism (SSE), six for LVT resolution, and five for bleeding events.
• Meta-analysis of pooled data using odds ratios (OR) and confidence intervals (CI).

Main Results:

• No statistically significant difference in SSE between DOACs and VKAs (OR 0.89; 95% CI 0.46, 1.71; p = 0.73).
• No significant difference in LVT resolution rates (OR 1.13; 95% CI 0.75, 1.71; p = 0.56).
• DOACs were associated with significantly lower bleeding event rates compared to VKAs (OR 0.61; 95% CI 0.40, 0.93; p = 0.02).

Conclusions:

• DOACs demonstrate comparable efficacy to VKAs for LVT treatment.
• DOACs offer a significant safety advantage due to reduced bleeding events.
• Further randomized controlled trials are needed to directly compare DOACs and VKAs for LVT.