The Role of Direct Oral Anticoagulants Versus Vitamin K Antagonists in the Treatment of Left Ventricular Thrombi: A Meta
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SYSTEMATIC REVIEW
The Role of Direct Oral Anticoagulants Versus Vitamin K Antagonists in the Treatment of Left Ventricular Thrombi: A Meta‑Analysis and Systematic Review Abdullah Al‑abcha1 · Khader Herzallah2 · Yehia Saleh3,4 · Mark Mujer1 · Ola Abdelkarim4 · Mahmoud Abdelnabi4 · Abdallah Almaghraby4 · George S. Abela5 Accepted: 17 November 2020 © Springer Nature Switzerland AG 2020
Abstract Background Direct oral anticoagulants (DOACs) have a well-established role in the treatment of deep vein thrombosis and pulmonary embolism and in the reduction of thromboembolism in nonvalvular atrial fibrillation. However, limited evidence supports their role in patients with left ventricular thrombi. Methods The PubMed, EMBASE, and Cochrane databases were searched for relevant articles published from inception to 1 August 2020. We included studies evaluating the effect of DOACs versus vitamin K antagonists (VKAs) in patients with left ventricular thrombi. The primary outcome was thrombus resolution, and the secondary outcomes were major bleeding and stroke or systemic embolization (SSE). Results Five retrospective observational studies were included, with a total of 857 patients. VKAs and DOACs had a similar rate of thrombus resolution (odds ratio [OR] 0.97; 95% confidence interval [CI] 0.57–1.65; p = 0.90). Our analysis also demonstrated a similar rate of major bleeding (OR 0.62; 95% CI 0.27–1.44; p = 0.27) and SSE (OR 1.86; 95% CI 0.99–3.50; p = 0.05) between the two treatment groups. Conclusion In patients with left ventricular thrombi, DOACs and VKAs are associated with similar rates of thrombus resolution, major bleeding, and SSE.
Key Points
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s40256-020-00458-2) contains supplementary material, which is available to authorized users. * Abdullah Al‑abcha [email protected] 1
Department of Internal Medicine, Michigan State University, East Lansing, MI, USA
2
Department of Cardiology, Tufts University, Boston, MA, USA
3
Department of Cardiology, Houston Methodist Hospital, Houston, TX, USA
4
Department of Cardiology, Alexandria University, Alexandria, Egypt
5
Department Cardiology, Michigan State University, East Lansing, MI, USA
Pooled data from observational studies showed that resolution rates for left ventricular thrombi are similar between direct oral anticoagulants (DOACs) and vitamin K antagonists (VKAs). DOACs and VKAs are associated with similar bleeding risks and systemic embolization in the treatment of left ventricular thrombi.
1 Introduction Left ventricular (LV) thrombus formation results from the presence of Virchow’s triad: reduced wall motion leading to stasis of blood, hypercoagulability, and local myocardial injury [1, 2]. In the pre-reperfusion era, myocardial Vol.:(0123456789)
infarctions (MIs) were commonly complicated by LV thrombus formation. Nowadays, given the advancements in reperfusion techniques, the prevalence of LV thrombi is around 1.6–5% in patients with ST-segmen
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