Meta-Analysis of Randomised Controlled Trials on the Efficacy of Direct Oral Anticoagulants in Left Ventricular Thrombosis: An Updated Perspective.

BACKGROUND

Left ventricular thrombus (LVT) is associated with significant morbidity and mortality. Current guidelines recommend direct oral anticoagulants (DOACs) and vitamin K antagonists for LVT treatment, although these recommendations are based on limited randomised data. However, a substantial body of new evidence has emerged, prompting the re-assessment of the optimal anticoagulation strategy.

AIM: This study aimed to conduct a systematic review and meta-analysis to assess the efficacy and safety profile of DOACs compared with warfarin in the management of LVT.

METHOD: We systematically searched three databases, restricting inclusion to randomised controlled trials comparing DOACs with warfarin. The primary outcomes were overall thrombus resolution and major bleeding events. Secondary outcomes were 1-month and 3-month thrombus resolution, all-cause mortality, and stroke. Dichotomous data were pooled as risk ratios (RRs) using an inverse variance random-effects model.

RESULTS

Seven randomised controlled trials were included, providing data on 553 patients. No significant differences were observed in overall thrombus resolution (RR=1.00 [0.96-1.04]; I2=0%) or major bleeding events (RR=0.54 [0.20-1.48]; I2=0%). There was no statistically significant difference in 1-month thrombus resolution (RR=1.35 [0.73-2.51]; I2=72%), 3-month thrombus resolution (RR=1.00 [0.96-1.05]; I2=0%), all-cause mortality (RR=0.83 [0.31-2.17]; I2=0%), or stroke (RR=0.87 [0.17-4.53]; I2=31%).

CONCLUSIONS

DOACs appear to be effective and safe alternatives to warfarin for LVT management, offering the advantages of a simpler dosing regimen and easier management.