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Direct Oral Anticoagulants Compared with Vitamin K Antagonists for Left Ventricular Thrombus: A Systematic Review and

Shu Fang1, Bao-Zhen Zhu1, Fan Yang1

  • 1Department of Cardiology, Peking University First Hospital, Beijing 100034, China.

Current Pharmaceutical Design
|April 11, 2022
PubMed

Insights

Direct oral anticoagulants (DOACs) and vitamin K antagonists (VKAs) show similar safety and efficacy for left ventricular thrombus (LVT) treatment. However, DOACs may offer improved outcomes for patients post-acute myocardial infarction (AMI).

Area of Science:

  • Cardiology
  • Pharmacology
  • Clinical Research

Background:

  • Direct oral anticoagulants (DOACs) are guideline-recommended for hypercoagulable diseases.
  • Their use for left ventricular thrombus (LVT) is off-label due to limited evidence.
  • This meta-analysis compares DOACs with vitamin K antagonists (VKAs) for LVT treatment.

Purpose of the Study:

  • To assess the safety and efficacy of DOACs versus VKAs in treating left ventricular thrombus (LVT).
  • To evaluate outcomes including stroke, systemic embolism, thrombus resolution, bleeding, and mortality.

Main Methods:

  • A meta-analysis of 12 observational studies involving 2262 patients.
  • Searched PubMed, EMBASE, Cochrane Library, and Web of Science databases.
  • Analyzed data using Review Manager 5.3; registered at PROSPERO.

Main Results:

  • No significant differences were found between DOACs and VKAs for stroke or systemic embolism (SSE), thrombus resolution, bleeding risk, or mortality.
  • Subgroup analysis indicated DOACs may reduce SSE and bleeding risk in post-acute myocardial infarction (AMI) patients.
  • Overall efficacy and safety profiles were comparable across treatments.

Conclusions:

  • DOACs and VKAs demonstrate similar safety and efficacy for LVT treatment.
  • DOACs may present a superior option for LVT management in post-AMI patients.
  • Further research could solidify DOACs' role in specific LVT patient populations.
Abstract

Keywords:
Left ventricular thrombusdirect oral anticoagulantsischemic bowelsystolic functionvitamin K antagonistswarfarin

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