DIRECT ORAL ANTICOAGULANTS VERSUS VITAMIN K ANTAGONIST FOR LEFT VENTRICULAR THROMBUS: AN UPDATED META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS AND COHORT STUDIES

Wasawat Vutthikraivit; Pavida Pachariyanon; Pattara Rattanawong; Prapaipan Putthapiban; Suvasini Lakshmanan; Paul Jae-Hyuk Lee; Elias Hanna

doi:10.1016/S0735-1097(22)01251-7

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DIRECT ORAL ANTICOAGULANTS VERSUS VITAMIN K ANTAGONIST FOR LEFT VENTRICULAR THROMBUS: AN UPDATED META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS AND COHORT STUDIES

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DIRECT ORAL ANTICOAGULANTS VERSUS VITAMIN K ANTAGONIST FOR LEFT VENTRICULAR THROMBUS: AN UPDATED META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS AND COHORT STUDIES

Wasawat Vutthikraivit, Pavida Pachariyanon, Pattara Rattanawong, Prapaipan Putthapiban, Suvasini Lakshmanan, Paul Jae-Hyuk Lee and Elias Hanna

Journal of the American College of Cardiology, Vol.79(9 Supplement), p.260

03/2022

DOI: 10.1016/S0735-1097(22)01251-7

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Abstract

Background: Left ventricular (LV) thrombus can occur consequently after acute myocardial infarction, as well as severe LV systolic dysfunction. Optimal anticoagulation strategy, whether vitamin K antagonist (VKA) or direct oral anticoagulant (DOAC), is controversial in this population. Methods: We comprehensively searched the databases of MEDLINE and EMBASE from inception to October 2021. Included studies were published cohort or randomized controlled trial (RCT) that compared thrombus resolution, systemic embolism, and bleeding between DOACs-treated and VKA-treated in patients with LV thrombus. Data from each study were combined using the random-effects model. Results: Nine studies (7 cohort studies and 2 RCTs) were included involving 668 patients with LV thrombus (455 received VKA and 213 received DOACs). There was no significant difference in thrombus resolution rate between two groups ([OR] 1.17, 95% CI 0.80-1.72, I2=0%, p=0.420) (Figure 1). Systemic embolism and bleeding rates were significant lower in patients received DOACs compared to VKA ([OR] 0.39, 95% CI 0.17-0.86, I2=0%, p=0.020 and [OR] 0.49, 95% CI 0.27-0.91, I2=0%, p=0.025, respectively) (Figure 1). There was no publication bias observed in funnel plot. Conclusion: As compared to VKA, our study showed that DOACs was associated with similar thrombus resolution rate but with lower incidence rate of systemic embolism and bleeding events. Direct oral anticoagulation could be considered as an alternative treatment in this setting.

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Title: Subtitle: DIRECT ORAL ANTICOAGULANTS VERSUS VITAMIN K ANTAGONIST FOR LEFT VENTRICULAR THROMBUS: AN UPDATED META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS AND COHORT STUDIES
Creators: Wasawat Vutthikraivit - University of Iowa
Pavida Pachariyanon - University of Iowa
Pattara Rattanawong - University of Iowa
Prapaipan Putthapiban - University of Iowa
Suvasini Lakshmanan - University of Iowa
Paul Jae-Hyuk Lee - University of Iowa
Elias Hanna - University of Iowa
Resource Type: Abstract
Publication Details: Journal of the American College of Cardiology, Vol.79(9 Supplement), p.260
DOI: 10.1016/S0735-1097(22)01251-7
ISSN: 0735-1097
eISSN: 1558-3597
Language: English
Date published: 03/2022
Academic Unit: Cardiovascular Medicine; Internal Medicine
Record Identifier: 9984695666102771

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