Direct Oral Anticoagulants Found to Be Safe and Effective to Treat LV Thrombosis

Direct oral anticoagulants (DOACs) were found to be safe and efficacious treatment for left ventricular (LV) thrombosis, according to a systematic review and meta-analysis. The results of these studies were published in the Journal of Cardiovascular Electrophysiology.

Investigators searched publication databases through September 2020 for studies of DOACs compared with vitamin K antagonists (VKAs) for the treatment of LV thrombosis. The analysis included a total of 12 studies comprising 867 patients (VKA: n=528; DOAC: n=339). Of these studies published between 2017 and 2020, 8 had retrospective designs, 3 were case series, and 1 was prospective.

The DOAC and VKA cohorts were 80% and 76.3% men with a mean age of 59.3±13.8 years and 60.7±13.7 years, respectively. The most common comorbidities among the DOAC and VKA groups were hypertension (65% and 61.5%), coronary artery disease (61% and 64.4%), and ischemic cardiomyopathy (60.9% and 68.3%), respectively.

Among studies of DOACs alone, the rate of systemic thromboembolism events was 2.7% (95% CI, 0.78-5.35; I² =2%); overall bleeding was 5.6% (95% CI, 2.06-10.18; I² =0); major bleeding was 1.1% (95% CI, 0-4.05; I² =0); and thrombus resolution was 86.6% (95% CI, 75.48-95.23; I² =51%).

No significant difference in systemic thromboembolism events was observed for studies comparing DOACs with VKAs (odds ratio [OR], 0.81; 95% CI, 0.44-1.52; P =.54; I²=0).

The risk for overall bleeding events was lower among DOAC recipients (OR, 0.33; 95% CI, 0.14-0.81; P =.02; I² =0). For major bleeding events, the researchers observed no significant differences (OR, 0.29; 95% CI, 0.07-1.26; P =.24; I² =0).

No significant effect on failure of thrombus resolution was found on the basis of DOAC or VKA therapy (OR, 0.86; 95% CI, 0.28-2.58; P =.68; I²=41%).

This study may have been limited by combining studies that diagnosed LV thrombosis with varied imaging modalities; however, the investigators reported little evidence of publication bias.

This study reported that risk for systemic thromboembolism events, major bleeding events, and failure to resolve LV thrombosis was similar between DOACs and VKAs, indicating DOACs are likely an efficacious and safe alternative for the treatment of LV thrombosis.

Reference

Shah S, Shah K, Turagam MK, et al. Direct oral anticoagulants to treat left ventricular thrombus — a systematic review and meta‐analysis: ELECTRAM investigators. J Cardiovasc Electrophysiol. Published online March 26, 2021. doi:10.1111/jce.15016