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.

中文翻译：

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直接口服抗凝剂与维生素 K 拮抗剂在左室血栓治疗中的作用：荟萃分析和系统评价

背景

直接口服抗凝剂 (DOAC) 在治疗深静脉血栓形成和肺栓塞以及减少非瓣膜性房颤血栓栓塞方面具有公认的作用。然而，有限的证据支持它们在左心室血栓患者中的作用。

方法

在 PubMed、EMBASE 和 Cochrane 数据库中搜索了从成立到 2020 年 8 月 1 日发表的相关文章。我们纳入了评估 DOAC 与维生素 K 拮抗剂 (VKA) 对左心室血栓患者效果的研究。主要结果是血栓消退，次要结果是大出血和中风或全身栓塞 (SSE)。

结果

共纳入 5 项回顾性观察研究，共 857 名患者。VKA 和 DOAC 的血栓消退率相似（优势比 [OR] 0.97；95% 置信区间 [CI] 0.57-1.65；p = 0.90）。我们的分析还表明，两个治疗组之间的大出血率（OR 0.62；95% CI 0.27–1.44；p = 0.27）和 SSE（OR 1.86；95% CI 0.99–3.50；p = 0.05）相似。

结论

在左心室血栓患者中，DOAC 和 VKA 与血栓消退、大出血和 SSE 的发生率相似。