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Comparative effectiveness and safety of DOACs vs. VKAs in treatment of left ventricular thrombus- a meta-analysis

Tong Hu1, Changli Chen1, Kellina Maduray1

  • 1National Key Laboratory for Innovation and Transformation of Luobing Theory; The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences; Department of Cardiology, Qilu Hospital of Shandong University, 107 Wen Hua Xi Road, Jinan, 250012, China.

Thrombosis Journal
|March 1, 2024
PubMed

Insights

Direct oral anticoagulants (DOACs) show comparable efficacy to Vitamin K antagonists (VKAs) for left ventricular thrombus (LVT) resolution. DOACs demonstrate superior safety, significantly reducing stroke, mortality, and bleeding events in LVT patients.

Area of Science:

  • Cardiology
  • Pharmacology

Background:

  • Left ventricular thrombus (LVT) is a common complication in acute myocardial infarction (AMI) and cardiomyopathies.
  • Optimal oral anticoagulation for LVT resolution remains debated, with Vitamin K antagonists (VKAs) as the guideline-recommended choice.
  • Growing evidence supports the use of direct oral anticoagulants (DOACs) for LVT management.

Purpose of the Study:

  • To conduct a systematic review and meta-analysis comparing the efficacy and safety of DOACs versus VKAs in patients with LVT.
  • To evaluate outcomes including thrombus resolution, ischemic events, mortality, and bleeding complications.

Main Methods:

  • A comprehensive literature search was performed across major databases (PubMed, Cochrane, Web of Science, Embase, Scopus) in July 2023.
  • Efficacy outcomes included thrombus resolution, stroke, systemic embolism, all-cause mortality, and adverse cardiovascular events.
  • Safety outcomes comprised any bleeding, major bleeding, and intracranial hemorrhage. Twenty-seven studies were included in the meta-analysis.

Main Results:

  • No significant difference in LVT resolution was observed between DOACs and VKAs (RR=1.00, P=0.99).
  • Overall, DOACs significantly reduced the risk of stroke (RR=0.74, P=0.021), all-cause mortality (RR=0.70, P=0.001), any bleeding (RR=0.75, P=0.006), and major bleeding (RR=0.67, P=0.001) compared to VKAs.
  • Subgroup analysis of randomized controlled trials (RCTs) showed no significant differences for these outcomes. Rivaroxaban specifically showed a reduced risk of stroke compared to VKAs (RR=0.24, P=0.011).

Conclusions:

  • DOACs offer non-inferior efficacy and superior safety compared to VKAs for LVT treatment.
  • DOACs represent a promising alternative therapeutic option for managing left ventricular thrombus.
  • Further robust research is recommended to validate these findings.
Abstract

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