Minerva Cardiology and Angiology 2022 Jan 26

DOI: 10.23736/S2724-5683.21.05893-2

Copyright © 2021 EDIZIONI MINERVA MEDICA

language: English

Direct oral anticoagulants versus Vitamin K antagonists in the treatment of left ventricular thrombosis: a systematic review and meta-analysis

Francesco CONDELLO ^{1, 2}, Matteo MAURINA ^{1, 2}, Mauro CHIARITO ^{1, 2}, Matteo STURLA ², Riccardo TERZI ², Fabio FAZZARI ^{1, 2}, Jorge SANZ-SANCHEZ ^{3, 4}, Francesco CANNATA ^{1, 2}, Gianluigi CONDORELLI ^{1, 2}, Giulio G. STEFANINI ^{1, 2} ✉

¹ Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; ² IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy; ³ Hospital Universitario y Politécnico La Fe, Valencia, Spain; ⁴ Centro de Investigacion Biomedica en Red Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain

INTRODUCTION: Evidence about the use of direct oral anticoagulants (DOACs) in patients with left ventricular thrombosis (LVT) are emerging. The aim of our study was to provide a comprehensive synthesis of the available evidence concerning the clinical effects of DOACs versus vitamin K antagonists (VKAs) in LVT treatment.
EVIDENCE ACQUISITION: Systematic search of studies evaluating DOACs versus VKAs use in patients with LVT was performed on May 11th, 2021. Data were pooled by meta-analysis using a random-effects model. Odds ratios (OR) with relative 95% confidence intervals (CI) were used as measures of effect estimates. The primary efficacy and safety endpoint were ischemic stroke and any bleeding, respectively. Secondary endpoints were LVT resolution, systemic embolism, major bleeding, hemorrhagic stroke, and all cause death.
EVIDENCE SYNTHESIS: Twenty studies were included in the meta-analysis: 1,391 patients were treated with DOACs and 1,534 with VKAs. A significant reduction in the risk of ischemic stroke (OR 0.67, 95% CI, 0.45-0.98, P = 0.048, number needed to treat to benefit [NNTB] 22 [95% CI 15-43]) and any bleeding (OR 0.64, 95% CI 0.46-0.89, P = 0.009, NNTB 26 [95% CI 16-80]) was observed with DOACs compared to VKAs. No statistically significant difference was observed among the two treatment arms for the secondary endpoints.
CONCLUSIONS: Compared to VKAs, DOACs are associated with a reduced risk of ischemic stroke and bleeding. In light of these findings, and the practical advantages of DOACs, additional large scale randomized controlled trials are needed to confirm the benefits of DOACs in patients with LVT.

KEY WORDS: Left ventricle thrombosis; Vitamin K antagonist; Direct oral anticoagulant; Meta-analysis