Meta-Analysis of Direct Oral Anticoagulants Compared With Vitamin K Antagonist for Left Ventricle Thrombus

Tanveer Mir; Yasar Sattar; Hassan Bin Attique; Tanveer Hussain; M Chadi Alraies; Mujeeb Sheikh; Waqas T Qureshi

doi:10.1016/j.carrev.2021.03.001

Meta-Analysis of Direct Oral Anticoagulants Compared With Vitamin K Antagonist for Left Ventricle Thrombus

Cardiovasc Revasc Med. 2022 Feb:35:141-146. doi: 10.1016/j.carrev.2021.03.001. Epub 2021 Mar 9.

Authors

Tanveer Mir¹, Yasar Sattar², Hassan Bin Attique³, Tanveer Hussain⁴, M Chadi Alraies⁵, Mujeeb Sheikh⁶, Waqas T Qureshi⁷

Affiliations

¹ Internal Medicine, Detroit Medical Center, Wayne State University. Detroit, MI, USA.
² Internal Medicine, Icahn School of Medicine at Mount Sinai, NY, USA.
³ Internal Medicine, University of Connecticut, Farmington, CT, USA.
⁴ Detroit Medical Center, Wayne State University, Detroit, MI, USA.
⁵ Cardiovascular Medicine, Detroit Medical Center, Wayne State University, Detroit, MI, USA.
⁶ Interventional Cardiology, Promedica Toledo Hospital, OH, USA.
⁷ Division of Cardiology, University of Massachusetts School of Medicine, Worcester, MA, USA. Electronic address: Waqas.Qureshi@umassmed.edu.

PMID: 33722539
DOI: 10.1016/j.carrev.2021.03.001

Abstract

Background: The use of direct oral anticoagulants (DOAC) in preference to vitamin K antagonists (VKA) as a treatment of left ventricle (LV) thrombus is controversial.

Methods: Literature search for full-text articles and conference abstracts was performed using PubMed, EMBASE databases search was performed to identify articles that compared use of DOAC vs. VKA in patients with LV thrombus. The primary outcome was composite failure or adverse effects of DOAC and VKA. Other outcomes were resolution of thrombus, systemic thromboembolism, major bleeding, and mortality. Pooled odds ratio (OR) with 95% confidence interval (CI) were computed using random effects model.

Results: Seven studies with 1003 patients (mean age DOAC = 58.8 years and VKA = 58.9 year, 55.5% males) were included in this study. There were 306 (30.5%) patients that were treated with DOAC and 697 (69.5%) patients were treated with VKA. Overall, there were no significant differences between both agents in terms of composite failure/adverse effects, resolution of thrombus, systemic embolism, major bleeding, or mortality.

Conclusion: In this pooled analysis, outcomes in patients on DOAC were comparable to VKA. The hypothesis generated could suggest DOAC could be used interchangeably with VKA in patients with LV thrombus. Randomized trials are needed for generalization of results.

Keywords: Direct oral anticoagulants; Left ventricle thrombus; Outcome; Vitamin K antagonists; Warfarin.

Publication types

Meta-Analysis

MeSH terms

Administration, Oral
Anticoagulants* / adverse effects
Anticoagulants* / therapeutic use
Female
Heart Ventricles* / diagnostic imaging
Humans
Male
Middle Aged
Thrombosis* / drug therapy
Vitamin K / antagonists & inhibitors*

Substances

Anticoagulants
Vitamin K