Related Experiment Video

Updated: Jan 15, 2026

The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
23:33

The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation

Published on: February 28, 2012

84.4K

An Updated Meta-Analysis of Randomized Controlled Trials Comparing Direct Oral Anticoagulants Against Warfarin for

Joseph Magdy1, Maggie He1, Sacchin Arockiam1

  • 1Yorkshire Heart Centre, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds LS1 3EX, UK.

Journal of Clinical Medicine
|October 16, 2025
PubMed

Insights

Direct oral anticoagulants (DOACs) show comparable efficacy to warfarin for resolving left ventricular thrombus (LVT) after myocardial infarction. This meta-analysis suggests DOACs are a viable alternative for LVT treatment in select patients.

Area of Science:

  • Cardiology
  • Pharmacology
  • Clinical Trials

Background:

  • Left ventricular thrombus (LVT) is a known complication post-myocardial infarction (MI).
  • Vitamin K antagonists (VKAs) are traditional treatments, but direct oral anticoagulants (DOACs) are increasingly used.
  • Limited data exists comparing DOACs and VKAs for LVT resolution.

Purpose of the Study:

  • To conduct an up-to-date meta-analysis of randomized controlled trials (RCTs).
  • To compare the efficacy of DOACs versus VKAs in achieving LVT resolution.
  • To evaluate safety outcomes including bleeding and thromboembolic events.

Main Methods:

  • Systematic search of scientific databases for RCTs up to May 2025.
  • Primary efficacy endpoint: complete LVT resolution at 3 months.
  • Pooled risk ratios (RR) and 95% confidence intervals (CIs) using random-effects model.

Main Results:

  • Seven RCTs with 554 patients were analyzed.
  • No significant difference in LVT resolution at 3 months between DOACs (86%) and warfarin (81%) (RR 1.01, 95%CI 0.93-1.10, p=0.76).
  • Similar rates for major bleeding and composite of stroke/thromboembolic complications, though CIs were wide.

Conclusions:

  • DOACs demonstrate comparable efficacy to warfarin for LVT resolution at 3 months.
  • Findings support considering DOACs as an alternative to VKAs for selected LVT patients.
  • Further large-scale trials are needed to confirm safety and compare specific DOACs.

Keywords:
bleedingdirect oral anticoagulantsembolic complicationsleft ventricular thrombusvitamin K antagonists

More Related Videos

A Multicenter MRI Protocol for the Evaluation and Quantification of Deep Vein Thrombosis10:26

A Multicenter MRI Protocol for the Evaluation and Quantification of Deep Vein Thrombosis

Published on: June 2, 2015

17.8K
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation28:13

Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation

Published on: February 26, 2013

33.9K

Related Concept Videos

Anticoagulant Drugs: Vitamin K Antagonists and Direct Oral Anticoagulants01:18

Anticoagulant Drugs: Vitamin K Antagonists and Direct Oral Anticoagulants

Oral anticoagulants are vital tools in preventing and treating blood clotting disorders. This diverse class of medications can be categorized as vitamin K antagonists, exemplified by warfarin, and direct thrombin inhibitors (DTIs), such as dabigatran, as well as factor Xa inhibitors, including rivaroxaban.
Warfarin, a prominent vitamin K antagonist family member, exerts its effect by inhibiting the enzyme VKORC1 (vitamin K epoxide reductase complex 1). By hindering this enzyme, warfarin...
2.1K
Venous Thrombosis III: Interprofessional Care01:29

Venous Thrombosis III: Interprofessional Care

Venous thrombosis requires effective prevention and treatment strategies to improve patient outcomes and reduce potential complications.Prevention StrategiesHealthcare providers must prioritize preventing venous thromboembolism (VTE) for all adult patients upon admission. Interventions depend on bleeding and thrombosis risk, medical history, current medications, diagnoses, planned procedures, and patient preferences. Patients on bed rest should change positions every two hours and, if not...
278
Anticoagulant Drugs: Low-Molecular-Weight Heparins01:30

Anticoagulant Drugs: Low-Molecular-Weight Heparins

Hemostasis is a crucial process that prevents excessive blood loss from damaged blood vessels. It involves various mechanisms such as vasoconstriction, platelet adhesion and activation, and fibrin formation. The importance of each mechanism depends on the type of vessel injury. In contrast, thrombosis is the abnormal formation of a blood clot within the blood vessels, leading to potential complications if the clot obstructs blood flow. Thrombosis can be caused by increased coagulability of the...
1.7K
Acute Coronary Syndrome III: Diagnostic Studies01:30

Acute Coronary Syndrome III: Diagnostic Studies

Diagnosing acute coronary syndrome or ACS begins with a thorough patient history. Notable symptoms include central, crushing chest pain radiating to the left arm, neck, jaw, or back, along with shortness of breath, sweating (diaphoresis), nausea, vomiting, dizziness, and palpitations.It is crucial to note any history of cardiac illnesses and assess risk factors, including age, gender, smoking, hypertension, diabetes, hyperlipidemia, and a sedentary lifestyle.During physical examination, vital...
209
Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care01:29

Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care

Diagnosing Pulmonary EmbolismDiagnosing pulmonary embolism (PE) involves clinical assessment and advanced imaging tests. The preferred diagnostic tool is the spiral (helical) CT scan or CT angiography (CTA), which uses intravenous contrast media to visualize the pulmonary vasculature and identify emboli.A ventilation-perfusion (V/Q) scan is an alternative for patients unable to receive contrast media. This scan includes both perfusion and ventilation scanning. Perfusion scanning involves...
311
Venous Thrombosis II: Clinical Manifestations and Diagnostic Studies01:20

Venous Thrombosis II: Clinical Manifestations and Diagnostic Studies

The key difference between Superficial Vein Thrombosis (SVT) and Deep Vein Thrombosis (DVT) lies in their location and severity.Clinical ManifestationsSVT typically presents with localized pain, tenderness, and redness along the course of a superficial vein, often accompanied by a palpable, cord-like structure under the skin. This condition is usually less dangerous than DVT but can be uncomfortable and may lead to complications such as cellulitis or, rarely, a clot extension into the deep...
286