Details

Autor(en) / Beteiligte

• Nso, Nso
• EMMANUEL, KELECHI
• Ayinde, Hakeem
• Iluyomade, Adedapo

Titel

Abstract 12654: Direct Oral Anticoagulants (DOAC) versus Warfarin for the Treatment of Left Ventricular Thrombus (LVT) in Patients With or Without Cardiorenal Comorbidities, Including CKD (Chronic Kidney Disease) and Atrial Fibrillation: A Systematic Review and Meta-Analysis

Ist Teil von

• Circulation (New York, N.Y.), 2021-11, Vol.144 (Suppl_1)

Erscheinungsjahr

2021

Quelle

EZB Electronic Journals Library

Beschreibungen/Notizen

• Abstract only Background: The medical management of left ventricular thrombus (LVT) is very challenging due to the risk of embolic events. The current body of evidence supports the use of DOACs (direct oral anticoagulants) as safe substitutes to vitamin K antagonists/warfarin. We aim to identify the credibility of the evidence-based claims that advocate the safety/efficacy of DOACs in comparison to warfarin therapy for LVT patients. Methods: We systematically explored PubMed/Medline, JSTOR, Google Scholar, and Cochrane Library to identify relevant studies published between January 2006 and April 2021. The included studies categorically compared various clinical endpoints related to the safety/efficacy of DOACs versus warfarin in LVT scenarios. Results: We extracted 23 studies on 172,038 adult patients who received treatment for LVT and/or cardiorenal comorbidities via DOACs or warfarin. The odds ratios for all-cause mortality (OR: 1.08, 95% CI 0.69, 1.71), arterial thrombus (OR: 0.74 [95% CI 0.03, 18.76]), bleeding complications (OR: 1.16 [95% CI 0.67, 2.02]), composite of deep venous thrombosis or pulmonary embolism (OR: 0.95 [95% CI 0.10, 8.99]), hemorrhagic stroke (OR: 0.53 [95% CI 0.02, 13.30]), composite of stroke or systemic embolism (OR: 1.08, 95% CI 0.64, 1.83), systemic embolism (OR: 0.53 [95% CI 0.02, 13.30]), and rate of thrombus resolution for DOACs (versus warfarin) (OR: 1.32 [95% CI 0.66, 2.62]) supported their safety/efficacy in LVT treatment. The subgroup analysis affirmed the safety/efficacy of betrixaban and rivaroxaban (as compared to warfarin) in minimizing the episodes of stroke/ischemic stroke and clinically relevant/intracranial hemorrhage in patients with/without cardiorenal comorbidities. Conclusion: We found no difference in therapeutic efficacy and safety of DOACs as compared to warfarin in managing the clinical complications of left ventricular thrombus. The findings advocate the need for prospective randomized controlled trials to validate the safe replacement of warfarin with DOACs in LVT patients.