A Meta-Analysis for the Efficacy and Safety of Direct Oral Anticoagulants versus Vitamin K Antagonists for Left Ventricular Thrombus

Authors

  • Gian Chand National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
  • Abdul Hameed National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
  • Rukhsar Bibi National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
  • Iram Jehan Balouch National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
  • Ijaz Ul Haq National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
  • Muhammad Tahseen Raza National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
  • Ahmed Raheem Aga Khan University Hospital, Karachi, Pakistan

DOI:

https://doi.org/10.47144/phj.v56i3.2611

Abstract

Objectives: The objective of this updated meta-analysis is to consolidate high-quality peer-reviewed clinical evidence, including trials and observational studies, to evaluate the efficacy and safety of “direct oral anticoagulants (DOACs)” versus “vitamin K antagonists (VKAs)” for treating “left ventricular thrombus (LVT)”.

Methodology: We included studies of either "observational" or "experimental" in nature reported original data for the head-to-head comparison of "DOACs" and "VKAs" for the treatment of LVT. The efficacy-related outcome of interest was "thrombus resolution" and safety-related outcomes of interest were; "mortality", "major bleeding", and "stroke". The “risk ratios (RRs)” for each outcome variable were calculated using the “Mantel-Haenszel method”.

Results: The analysis included 19 studies comprised of 3,027 patients diagnosed with LVT. Among them, 881 received DOAC treatment, while 2,146 were treated with VKAs. DOACs showed comparable rates of LVT resolution (RR: 1.00 [0.93 – 1.08]), lower mortality incidence (RR: 0.65 [0.51 – 0.84]), similar stroke incidence (RR: 0.83 [0.61 – 1.14]), and similar major bleeding incidence (RR: 0.71 [0.50 – 1.00]) compared to VKAs.

Conclusion: The meta-analysis indicates that DOACs are as effective as VKAs for treating LVT, showing comparable thrombus resolution rates, lower all-cause mortality, similar stroke risks, and clinically relevant bleeding across studies. However, these conclusions are limited by the lack of evidence from large-scale randomized studies and high-quality real-life clinical data.

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Published

2023-09-30

How to Cite

1.
Chand G, Hameed A, Bibi R, Balouch IJ, Haq IU, Raza MT, Raheem A. A Meta-Analysis for the Efficacy and Safety of Direct Oral Anticoagulants versus Vitamin K Antagonists for Left Ventricular Thrombus. Pak Heart J [Internet]. 2023Sep.30 [cited 2024Sep.29];56(3):211-8. Available from: https://pakheartjournal.com/index.php/pk/article/view/2611

Issue

Vol. 56 No. 3 (2023): Pakistan Heart Journal

Section

Original Article

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