Background:

Current guidelines recommend vitamin K antagonists (VKAs) for left ventricular thrombus (LVT) resolution. Direct oral anticoagulants (DOACs) are increasingly evaluated as alternatives to the standard of care in anticoagulation.

Methods:

We performed a systematic review and meta-analysis to assess the use of DOACs vs VKAs for LVT treatment. The occurrence of LVT resolution, systemic embolism (SE) or stroke, and bleeding events were compared during follow-up using random-effects analysis.

Results:

The 5 included studies were all observational (a total of 828 patients). Of these, 284 patients (34%) were treated with DOACs, and 544 (66%) treated with VKAs. Thrombus resolution was similar for both methods (pooled odds ratio [OR], 0.91; 95% CI, 0.47-1.75; I² = 63%; P = .78). The incidence of SE or stroke was also similar (pooled OR, 1.59; 95% CI, 0.85-2.97; I² = 0%; P = .14). Clinically relevant bleeding incidence was similar for both groups (pooled OR, 0.66; 95% CI, 0.31-1.40; I² = 0%; P = .28), although all bleeding events were less frequent in the DOAC group (pooled OR, 0.49; 95% CI, 0.26-0.90; I² = 0%; P = .02).

Conclusion:

Our systematic review and meta-analysis suggests DOACs were as effective as VKAs for LVT resolution, with a similar risk of systemic embolism/stroke and clinically relevant bleeding. These results, obtained from observational studies, are not definitive and hence randomized controlled trials are needed. Nevertheless, our analysis identifies key experimental features required in future studies.

中文翻译：

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直接口服抗凝剂与维生素 K 拮抗剂的左室血栓治疗：系统评价和荟萃分析

背景：

目前的指南推荐使用维生素 K 拮抗剂 (VKA) 来解决左心室血栓 (LVT)。直接口服抗凝剂 (DOAC) 被越来越多地评估为抗凝治疗标准的替代品。

方法：

我们进行了一项系统回顾和荟萃分析，以评估 DOAC 与 VKA 在 LVT 治疗中的应用。在随访期间使用随机效应分析比较 LVT 消退、全身性栓塞 (SE) 或中风以及出血事件的发生率。

结果：

纳入的 5 项研究均为观察性研究（共 828 名患者）。其中，284 名患者 (34%) 接受了 DOACs 治疗，544 名患者 (66%) 接受了 VKAs 治疗。两种方法的血栓消退率相似（合并优势比 [OR]，0.91；95% CI，0.47-1.75；I ² = 63%；P = .78）。SE 或中风的发生率也相似（合并 OR，1.59；95% CI，0.85-2.97；I ² = 0%；P = .14）。两组的临床相关出血发生率相似（合并 OR，0.66；95% CI，0.31-1.40；I ² = 0%；P = .28），尽管 DOAC 组的所有出血事件发生率较低（合并 OR， 0.49；95% CI，0.26-0.90；I ²= 0%; P = .02）。

结论：

我们的系统评价和荟萃分析表明，DOACs 与 VKAs 对 LVT 的解决同样有效，具有相似的全身性栓塞/中风和临床相关出血的风险。这些从观察性研究中获得的结果并不是确定性的，因此需要进行随机对照试验。尽管如此，我们的分析确定了未来研究所需的关键实验特征。