Meta-analysis comparing direct oral anticoagulants versus vitamin K antagonists in patients with left ventricular thrombus.

Current American College of Cardiology/American Heart Association guidelines for stroke or ST-elevation myocardial infarction recommend the use of oral vitamin K antagonists (VKAs) as a first-line anticoagulant. Although several studies have compared the use of direct oral anticoagulants (DOACs) to...

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Autores principales:	Kazuhiko Kido, Yasir Abdul Ghaffar, James C Lee, Christopher Bianco, Mikiko Shimizu, Tsuyoshi Shiga, Masayuki Hashiguchi
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/21c1cfb0f1bc47e3968ebeed42b64ed6
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spelling	oai:doaj.org-article:21c1cfb0f1bc47e3968ebeed42b64ed62021-12-02T20:07:17ZMeta-analysis comparing direct oral anticoagulants versus vitamin K antagonists in patients with left ventricular thrombus.1932-620310.1371/journal.pone.0252549https://doaj.org/article/21c1cfb0f1bc47e3968ebeed42b64ed62021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0252549https://doaj.org/toc/1932-6203Current American College of Cardiology/American Heart Association guidelines for stroke or ST-elevation myocardial infarction recommend the use of oral vitamin K antagonists (VKAs) as a first-line anticoagulant. Although several studies have compared the use of direct oral anticoagulants (DOACs) to VKAs for left ventricular thrombus (LVT) anticoagulation therapy, they are small scale and have produced conflicting results. Thus, this meta-analysis was performed to aggregate these studies to better compare the efficacy and safety of DOACs with VKAs in patients with LVT. Cochrane Library, Google Scholar, MEDLINE, and Web of Science database searches through January 10, 2021 were performed. Eight studies evaluating stroke or systemic embolism (SSE), six studies for LVT resolution, and five studies for bleeding were included. There were no statistically significant differences in SSE (OR 0.89; 95% CI 0.46, 1.71; p = 0.73; I2 = 45%) and LVT resolution (OR 1.13; 95% CI 0.75, 1.71; p = 0.56; I2 = 1%) between DOAC and VKA (reference group) therapy. DOAC use was significantly associated with lower bleeding event rates compared to VKA use (OR 0.61; 95% CI 0.40, 0.93; p = 0.02; I2 = 0%). DOACs may be feasible alternative anticoagulants to vitamin K antagonists for LV thrombus treatment. Randomized controlled trials directly comparing DOACs with VKAs are needed.Kazuhiko KidoYasir Abdul GhaffarJames C LeeChristopher BiancoMikiko ShimizuTsuyoshi ShigaMasayuki HashiguchiPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 6, p e0252549 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Kazuhiko Kido Yasir Abdul Ghaffar James C Lee Christopher Bianco Mikiko Shimizu Tsuyoshi Shiga Masayuki Hashiguchi Meta-analysis comparing direct oral anticoagulants versus vitamin K antagonists in patients with left ventricular thrombus.
description	Current American College of Cardiology/American Heart Association guidelines for stroke or ST-elevation myocardial infarction recommend the use of oral vitamin K antagonists (VKAs) as a first-line anticoagulant. Although several studies have compared the use of direct oral anticoagulants (DOACs) to VKAs for left ventricular thrombus (LVT) anticoagulation therapy, they are small scale and have produced conflicting results. Thus, this meta-analysis was performed to aggregate these studies to better compare the efficacy and safety of DOACs with VKAs in patients with LVT. Cochrane Library, Google Scholar, MEDLINE, and Web of Science database searches through January 10, 2021 were performed. Eight studies evaluating stroke or systemic embolism (SSE), six studies for LVT resolution, and five studies for bleeding were included. There were no statistically significant differences in SSE (OR 0.89; 95% CI 0.46, 1.71; p = 0.73; I2 = 45%) and LVT resolution (OR 1.13; 95% CI 0.75, 1.71; p = 0.56; I2 = 1%) between DOAC and VKA (reference group) therapy. DOAC use was significantly associated with lower bleeding event rates compared to VKA use (OR 0.61; 95% CI 0.40, 0.93; p = 0.02; I2 = 0%). DOACs may be feasible alternative anticoagulants to vitamin K antagonists for LV thrombus treatment. Randomized controlled trials directly comparing DOACs with VKAs are needed.
format	article
author	Kazuhiko Kido Yasir Abdul Ghaffar James C Lee Christopher Bianco Mikiko Shimizu Tsuyoshi Shiga Masayuki Hashiguchi
author_facet	Kazuhiko Kido Yasir Abdul Ghaffar James C Lee Christopher Bianco Mikiko Shimizu Tsuyoshi Shiga Masayuki Hashiguchi
author_sort	Kazuhiko Kido
title	Meta-analysis comparing direct oral anticoagulants versus vitamin K antagonists in patients with left ventricular thrombus.
title_short	Meta-analysis comparing direct oral anticoagulants versus vitamin K antagonists in patients with left ventricular thrombus.
title_full	Meta-analysis comparing direct oral anticoagulants versus vitamin K antagonists in patients with left ventricular thrombus.
title_fullStr	Meta-analysis comparing direct oral anticoagulants versus vitamin K antagonists in patients with left ventricular thrombus.
title_full_unstemmed	Meta-analysis comparing direct oral anticoagulants versus vitamin K antagonists in patients with left ventricular thrombus.
title_sort	meta-analysis comparing direct oral anticoagulants versus vitamin k antagonists in patients with left ventricular thrombus.
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/21c1cfb0f1bc47e3968ebeed42b64ed6
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Meta-analysis comparing direct oral anticoagulants versus vitamin K antagonists in patients with left ventricular thrombus.

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