Efficacy and Safety Profile of Novel Oral Anticoagulants in the Treatment of Left Atrial Thrombosis: A Systematic Review and Meta-Analysis

IF 1.6 Q3 MEDICINE, RESEARCH & EXPERIMENTAL

Current Therapeutic Research-clinical and Experimental Pub Date : 2022-01-01 DOI:10.1016/j.curtheres.2022.100670

Shu-Jie Dong MSc , Cong-Yan Luo MSc , Cui-Lan Xiao BSc , Feng-Zhe Zhang BSc , Lei Li MD , Zhong-Ling Han MSc , Suo-Di Zhai BSc

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引用次数: 1

Abstract

Background

The presence of left atrial/left atrial appendage thrombosis is associated with a higher risk of thromboembolic events in patients with atrial fibrillation. The optimal antithrombotic strategy is not established to date.

Objective

Our aim was to compare the efficacy and safety profile of novel oral anticoagulants with warfarin in the treatment of left atrial/left atrial appendage thrombosis.

Methods

We conducted a systematic search in PubMed, Embase, Cochrane Library, ClinicalTrials.gov, and 3 Chinese databases for all randomized controlled trials and cohort studies (PROSPERO, CRD42021238952) from inception to 7 May 2021. Two authors independently performed the articles selection, data extraction, and quality assessment. The efficacy outcome was the resolution of left atrial/left atrial appendage thrombosis, and the safety outcomes were bleeding and stroke/transient ischemic attack.

Results

One randomized controlled trial and 5 cohort studies were included, with a total of 353 patients. Compared with warfarin, novel oral anticoagulants were associated with increased probability of left atrial/left atrial appendage thrombosis resolution (OR = 2.20; 95% CI, 1.35–3.60; I² = 0%). Compared with warfarin, novel oral anticoagulants had a similar risk of bleeding (OR = 0.91; 95% CI, 0.39–2.13; I² = 0%). There was no evidence of increased risk of stroke/transient ischemic attack (OR = 0.42; 95% CI, 0.12–1.45; I² = 0%).

Conclusions

Novel oral anticoagulants were more effective than warfarin in promoting the resolution of left atrial/left atrial appendage thrombosis, without increased risks of bleeding and stroke/transient ischemic attack. Our study provides valuable insight into clinical practice. Further well-designed randomized controlled trials are needed to fully evaluate the benefits and risks in these patients. PROSPERO Registration No.: CRD42021238952.

查看原文本刊更多论文

新型口服抗凝剂治疗左心房血栓的疗效和安全性:系统回顾和荟萃分析

背景左心房/左心房附件血栓形成与心房颤动患者发生血栓栓塞事件的高风险相关。迄今为止，最佳抗血栓策略尚未确定。目的比较新型口服抗凝剂与华法林治疗左房/左房附件血栓形成的疗效和安全性。方法系统检索PubMed、Embase、Cochrane Library、ClinicalTrials.gov和3个中文数据库(PROSPERO, CRD42021238952)自成立至2021年5月7日的所有随机对照试验和队列研究。两位作者独立进行文章选择、数据提取和质量评估。疗效指标为左心房/左心房附件血栓的消退，安全性指标为出血和卒中/短暂性脑缺血发作。结果纳入1项随机对照试验和5项队列研究，共353例患者。与华法林相比，新型口服抗凝剂与左心房/左心房附件血栓消退的可能性增加相关(OR = 2.20;95% ci, 1.35-3.60;I2 = 0%)。与华法林相比，新型口服抗凝剂的出血风险相似(OR = 0.91;95% ci, 0.39-2.13;I2 = 0%)。没有证据表明卒中/短暂性脑缺血发作的风险增加(OR = 0.42;95% ci, 0.12-1.45;I2 = 0%)。结论新型口服抗凝药物在促进左房/左房耳血栓的消退方面比华法林更有效，且不增加出血和卒中/短暂性脑缺血发作的风险。我们的研究为临床实践提供了宝贵的见解。需要进一步精心设计的随机对照试验来充分评估这些患者的获益和风险。普洛斯彼罗注册号: CRD42021238952。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Current Therapeutic Research-clinical and Experimental 医学-药学

CiteScore

3.50

自引率

0.00%

发文量

审稿时长

3 months

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