Journal article
Direct oral anticoagulants versus warfarin in adults with durable left ventricular assist devices: A systematic review and meta-analysis
Current problems in cardiology, Vol.49(12), 102871
10/04/2024
DOI: 10.1016/j.cpcardiol.2024.102871
PMID: 39369772
Abstract
The management of anticoagulation in patients with durable left ventricular assist devices (LVADs) is challenging. Traditionally, warfarin has been used, but its limitations have prompted interest in direct oral anticoagulants (DOACs). This meta-analysis aims to evaluate the safety and efficacy of DOACs compared to warfarin in LVAD patients.
We searched databases for studies comparing DOACs and warfarin in LVAD patients. Primary outcomes were thromboembolic events and major bleeding events. Secondary outcomes were the individual components of the thromboembolic events, minor bleeding events, and all-cause mortality. Random-effects model was used to calculate log risk-ratios (RR) with 95 % confidence intervals (CI).
Nine studies with a total of 316 LVAD patients (153 on DOACs, 163 on warfarin) were included. Thromboembolic events were similar between the groups (Log RR -0.42, 95 % CI:1.29 to 0.45, P = 0.34). Major bleeding events were significantly fewer in the DOAC group (Log RR -1.05, 95 % CI:1.73 to -0.36, P < 0.01). Minor bleeding events were also less common with DOACs (Log RR -0.77, 95 % CI:1.46 to -0.07, P = 0.03). No significant differences were observed in pump thrombosis, ischemic cerebrovascular accident events, or all-cause mortality.
DOACs appear to be a safe and effective alternative to warfarin for anticoagulation in LVAD patients, associated with fewer major and minor bleeding events. These findings support the consideration of DOACs in this patient population, though further research is needed to confirm these results and guide clinical practice.
Details
- Title: Subtitle
- Direct oral anticoagulants versus warfarin in adults with durable left ventricular assist devices: A systematic review and meta-analysis
- Creators
- Mohammed Mhanna - University of IowaMohammed Ayyad - Rutgers, The State University of New JerseyIbrahim Mortada - University of IowaAhmad Al-Abdouh - University of KentuckyAhmad Jabri - Beaumont Hospital, Royal OakAbdulmajeed Al-Harbi - Tufts Medical CenterMahmoud Barbarawi - University of ConnecticutAzizullah Beran - Indiana University – Purdue University IndianapolisErnesto Ruiz Duque - University of Iowa, Cardiovascular MedicineShareef Mansour - University of Iowa
- Resource Type
- Journal article
- Publication Details
- Current problems in cardiology, Vol.49(12), 102871
- Publisher
- Elsevier Inc
- DOI
- 10.1016/j.cpcardiol.2024.102871
- PMID
- 39369772
- ISSN
- 0146-2806
- eISSN
- 1535-6280
- Language
- English
- Date published
- 10/04/2024
- Academic Unit
- Cardiovascular Medicine; Internal Medicine
- Record Identifier
- 9984722561002771
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