Comparative effectiveness and safety of DOACs vs. VKAs in treatment of left ventricular thrombus- a meta-analysis update

IF 2.6 4区医学 Q2 HEMATOLOGY

Thrombosis Journal Pub Date : 2024-03-01 DOI:10.1186/s12959-024-00585-9

Tong Hu, Changli Chen, Kellina Maduray, Wenqiang Han, Tongshuai Chen, Jingquan Zhong

{"title":"Comparative effectiveness and safety of DOACs vs. VKAs in treatment of left ventricular thrombus- a meta-analysis update","authors":"Tong Hu, Changli Chen, Kellina Maduray, Wenqiang Han, Tongshuai Chen, Jingquan Zhong","doi":"10.1186/s12959-024-00585-9","DOIUrl":null,"url":null,"abstract":"Left ventricular thrombus (LVT) formation in patients with acute myocardial infarction (AMI) or cardiomyopathies is not uncommon. The optimal oral anticoagulation therapy for resolving LVT has been under intense debate. Vitamin K antagonists (VKAs) remain the anticoagulant of choice for this condition, according to practice guidelines. Evidence supporting the use of direct oral anticoagulants (DOACs) in the management of LVT continues to grow. We performed a systematic review and meta-analysis to compare the efficacy and safety of DOACs versus VKAs. A comprehensive literature search was carried out in PubMed, Cochrane Library, Web of Science, Embase, and Scopus databases in July 2023. The efficacy outcomes of this study were thrombus resolution, ischemic stroke, systemic embolism, stroke/systemic embolism, all-cause mortality, and adverse cardiovascular events. The safety outcomes were any bleeding, major bleeding, and intracranial hemorrhage. A total of twenty-seven eligible studies were included in the meta-analysis. Data were analyzed utilizing Stata software version 15.1. There was no significant difference between DOACs and VKAs with regard to LVT resolution (RR = 1.00, 95% CI 0.95–1.05, P = 0.99). In the overall analysis, DOACs significantly reduced the risk of stroke (RR = 0.74, 95% CI 0.57–0.96, P = 0.021), all-cause mortality (RR = 0.70, 95% CI 0.57–0.86, P = 0.001), any bleeding (RR = 0.75, 95% CI 0.61–0.92, P = 0.006) and major bleeding (RR = 0.67, 95% CI 0.52–0.85, P = 0.001) when compared to VKAs. Meanwhile, in the sub-analysis examining randomized controlled trials (RCTs), the aforementioned outcomes no longer differed significantly between the DOACs and VKAs groups. The incidences of systemic embolism (RR = 0.81, 95% CI 0.54–1.22, P = 0.32), stroke/systemic embolism (RR = 0.85, 95% CI 0.72–1.00, P = 0.056), intracranial hemorrhage (RR = 0.59, 95% CI 0.23–1.54, P = 0.28), and adverse cardiovascular events (RR = 0.99, 95% CI 0.63–1.56, P = 0.92) were comparable between the DOACs and VKAs groups. A subgroup analysis showed that patients treated with rivaroxaban had a significantly lower risk of stroke (RR = 0.24, 95% CI 0.08–0.72, P = 0.011) than those in the VKAs group. With non-inferior efficacy and superior safety, DOACs are promising therapeutic alternatives to VKAs in the treatment of LVT. Further robust investigations are warranted to confirm our findings.","PeriodicalId":22982,"journal":{"name":"Thrombosis Journal","volume":"257 1","pages":""},"PeriodicalIF":2.6000,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Thrombosis Journal","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1186/s12959-024-00585-9","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"HEMATOLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Left ventricular thrombus (LVT) formation in patients with acute myocardial infarction (AMI) or cardiomyopathies is not uncommon. The optimal oral anticoagulation therapy for resolving LVT has been under intense debate. Vitamin K antagonists (VKAs) remain the anticoagulant of choice for this condition, according to practice guidelines. Evidence supporting the use of direct oral anticoagulants (DOACs) in the management of LVT continues to grow. We performed a systematic review and meta-analysis to compare the efficacy and safety of DOACs versus VKAs. A comprehensive literature search was carried out in PubMed, Cochrane Library, Web of Science, Embase, and Scopus databases in July 2023. The efficacy outcomes of this study were thrombus resolution, ischemic stroke, systemic embolism, stroke/systemic embolism, all-cause mortality, and adverse cardiovascular events. The safety outcomes were any bleeding, major bleeding, and intracranial hemorrhage. A total of twenty-seven eligible studies were included in the meta-analysis. Data were analyzed utilizing Stata software version 15.1. There was no significant difference between DOACs and VKAs with regard to LVT resolution (RR = 1.00, 95% CI 0.95–1.05, P = 0.99). In the overall analysis, DOACs significantly reduced the risk of stroke (RR = 0.74, 95% CI 0.57–0.96, P = 0.021), all-cause mortality (RR = 0.70, 95% CI 0.57–0.86, P = 0.001), any bleeding (RR = 0.75, 95% CI 0.61–0.92, P = 0.006) and major bleeding (RR = 0.67, 95% CI 0.52–0.85, P = 0.001) when compared to VKAs. Meanwhile, in the sub-analysis examining randomized controlled trials (RCTs), the aforementioned outcomes no longer differed significantly between the DOACs and VKAs groups. The incidences of systemic embolism (RR = 0.81, 95% CI 0.54–1.22, P = 0.32), stroke/systemic embolism (RR = 0.85, 95% CI 0.72–1.00, P = 0.056), intracranial hemorrhage (RR = 0.59, 95% CI 0.23–1.54, P = 0.28), and adverse cardiovascular events (RR = 0.99, 95% CI 0.63–1.56, P = 0.92) were comparable between the DOACs and VKAs groups. A subgroup analysis showed that patients treated with rivaroxaban had a significantly lower risk of stroke (RR = 0.24, 95% CI 0.08–0.72, P = 0.011) than those in the VKAs group. With non-inferior efficacy and superior safety, DOACs are promising therapeutic alternatives to VKAs in the treatment of LVT. Further robust investigations are warranted to confirm our findings.

查看原文本刊更多论文

DOACs 与 VKAs 治疗左心室血栓的有效性和安全性比较--最新荟萃分析

急性心肌梗死（AMI）或心肌病患者左心室血栓（LVT）的形成并不少见。解决左心室血栓的最佳口服抗凝疗法一直备受争议。根据实践指南，维生素 K 拮抗剂 (VKAs) 仍是治疗这种情况的首选抗凝剂。支持使用直接口服抗凝剂（DOACs）治疗 LVT 的证据不断增加。我们进行了一项系统综述和荟萃分析，以比较 DOAC 与 VKAs 的疗效和安全性。我们于 2023 年 7 月在 PubMed、Cochrane Library、Web of Science、Embase 和 Scopus 数据库中进行了全面的文献检索。本研究的疗效指标为血栓溶解、缺血性中风、全身性栓塞、中风/全身性栓塞、全因死亡率和不良心血管事件。安全性结果为任何出血、大出血和颅内出血。共有 27 项符合条件的研究被纳入荟萃分析。数据采用Stata软件15.1版进行分析。DOACs 和 VKAs 在 LVT 解救方面无明显差异（RR = 1.00，95% CI 0.95-1.05，P = 0.99）。在总体分析中，与 VKAs 相比，DOACs 能显著降低卒中风险（RR = 0.74，95% CI 0.57-0.96，P = 0.021）、全因死亡率（RR = 0.70，95% CI 0.57-0.86，P = 0.001）、任何出血（RR = 0.75，95% CI 0.61-0.92，P = 0.006）和大出血（RR = 0.67，95% CI 0.52-0.85，P = 0.001）。同时，在研究随机对照试验（RCT）的子分析中，DOACs 组和 VKAs 组的上述结果不再有显著差异。全身性栓塞（RR = 0.81，95% CI 0.54-1.22，P = 0.32）、卒中/全身性栓塞（RR = 0.85，95% CI 0.72-1.00，P = 0.056）、颅内出血（RR = 0.59，95% CI 0.23-1.54，P = 0.28）和不良心血管事件（RR = 0.99，95% CI 0.63-1.56，P = 0.92）在 DOACs 组和 VKAs 组之间具有可比性。一项亚组分析显示，接受利伐沙班治疗的患者发生中风的风险（RR = 0.24，95% CI 0.08-0.72，P = 0.011）明显低于VKAs组。DOACs具有非劣效性和优越的安全性，是治疗LVT的VKAs的有前途的替代治疗药物。为了证实我们的研究结果，有必要进行进一步的深入研究。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Thrombosis Journal Medicine-Hematology

CiteScore

3.80

自引率

3.20%

发文量

审稿时长

16 weeks

期刊介绍： Thrombosis Journal is an open-access journal that publishes original articles on aspects of clinical and basic research, new methodology, case reports and reviews in the areas of thrombosis. Topics of particular interest include the diagnosis of arterial and venous thrombosis, new antithrombotic treatments, new developments in the understanding, diagnosis and treatments of atherosclerotic vessel disease, relations between haemostasis and vascular disease, hypertension, diabetes, immunology and obesity.