Aim:

To compare the safety and efficacy of direct oral anticoagulants (DOAC) relative to vitamin K antagonists (VKA) for the treatment of left ventricular thrombus (LVT).

Methods:

This retrospective study enrolled patients diagnosed with LVT from 2014-2017. Patient characteristics and outcomes within 12 months of LVT diagnosis were recorded and analyzed. A meta-analysis was also performed by pooling our results with existing data in literature.

Results:

14 DOAC and 59 VKA patients were included. Baseline demographic and clinical characteristics were similar except for age. Although more strokes within 12 months occurred in VKA (15%) than in DOAC (0%) patients, this was not statistically significant (p = 0.189). There were no significant differences in outcomes between patients on DOAC and VKA for acute coronary syndrome (ACS) (7%, vs 3.4%, p = .477), LVT resolution (86% vs 76%, p = .499) or bleeding (14% vs 14%, p = 1) within 12 months. The meta-analysis included 6 studies (n = 408 for DOACs; n = 1207 for VKA). There were no significant differences between DOACs versus VKAs with respect to odds for unresolved thrombus (OR 0.61, 95% CI 0.26,1.41), embolic events (OR 1.24, 95% CI 0.90,1.69), embolic events and death (OR 1.10, 95% CI 0.84,1.45) or bleeding events (OR 1.13, 95% CI 0.74,1.72).

Conclusions:

Our study and meta-analysis suggest similar efficacy and safety of DOACs in the treatment of LVT compared to VKA. These findings underscore the need for a randomized controlled trial.

中文翻译：

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直接口服抗凝剂治疗左心室血栓：一项回顾性、多中心研究和现有数据的荟萃分析

目的：

比较直接口服抗凝剂 (DOAC) 与维生素 K 拮抗剂 (VKA) 治疗左心室血栓 (LVT) 的安全性和有效性。

方法：

这项回顾性研究招募了 2014-2017 年诊断为 LVT 的患者。记录和分析 LVT 诊断后 12 个月内的患者特征和结果。还通过将我们的结果与文献中的现有数据合并进行荟萃分析。

结果：

包括 14 名 DOAC 和 59 名 VKA 患者。除年龄外，基线人口统计学和临床​​特征相似。尽管 VKA (15%) 患者在 12 个月内的卒中发生率高于 DOAC (0%) 患者，但这没有统计学意义 (p = 0.189)。DOAC 和 VKA 患者在急性冠状动脉综合征 (ACS) (7%, vs 3.4%, p = .477)、LVT 分辨率 (86% vs 76%, p = .499) 或出血方面的结果没有显着差异（14% 对 14%，p = 1）在 12 个月内。荟萃分析包括 6 项研究（DOAC 的 n = 408；VKA 的 n = 1207）。DOACs 与 VKAs 在未解决血栓（OR 0.61, 95% CI 0.26,1.41）、栓塞事件（OR 1.24, 95% CI 0.90,1.69）、栓塞事件和死亡（OR 1.10, 95% CI 0.84,1.45) 或出血事件 (OR 1.13, 95% CI 0.74,1.72)。

结论：

我们的研究和荟萃分析表明，与 VKA 相比，DOACs 治疗 LVT 的疗效和安全性相似。这些发现强调了进行随机对照试验的必要性。