Direct Oral Anticoagulants versus Vitamin K Antagonists for Left Ventricular Thrombus: A Meta-Analysis with Trial Sequential Analysis Anticoagulantes Orais Diretos versus Antagonistas da Vitamina K para Trombo Ventricular Esquerdo: Uma Metanálise com Análise Sequencial de Ensaios

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dc.contributor.authorPasqualotto E.
dc.contributor.authorGewehr D.M.
dc.contributor.authorFerreira R.O.M.
dc.contributor.authorChavez M.P.
dc.contributor.authorSilva C.H.
dc.contributor.authorCruz S.A.
dc.contributor.authorLimachi-Choque J.
dc.contributor.authorPark A.
dc.contributor.authorde Azeredo Coutinho M.S.S.
dc.contributor.authorKubrusly L.F.
dc.date.accessioned2024-09-01T06:16:55Z
dc.date.available2024-09-01T06:16:55Z
dc.date.issued2024
dc.description.abstract© 2024, Sociedade Brasileira de Cardiologia. All rights reserved.Background: Vitamin K antagonists (VKAs) are the recommended first-line treatment for left ventricular thrombus (LVT); however, direct oral anticoagulants (DOACs) have been considered an alternative therapy. Objectives: To evaluate the efficacy and safety of DOACs compared with VKAs therapy in patients with LVT. Methods: PubMed, Embase, and Cochrane were systematically searched for randomized clinical trials or cohort studies that compared DOACs versus VKAs for LVT. Risk ratios (RRs) were computed for binary endpoints, with 95% confidence intervals (95% CIs). Statistical significance was defined as p value < 0.05. Results: A total of 4 randomized clinical trials and 29 cohort studies were included, with 4,450 patients assigned to either DOACs or VKAs. There was no significant difference between groups for stroke or systemic embolic (SSE) events (RR 0.84; 95% CI 0.65 to 1.07; p = 0.157), stroke (RR 0.73; 95% CI 0.48 to 1.11; p = 0.140), systemic embolic (SE) events (RR 0.69; 95% CI 0.40 to 1.17; p = 0.166), thrombus resolution (RR 1.05; 95% CI 0.99 to 1.11; p = 0.077), any bleeding (RR 0.78; 95% CI 0.60 to 1.00; p = 0.054), clinically relevant bleeding (RR 0.69; 95% CI 0.46 to 1.03; p = 0.066), minor bleeding (RR 0.73; 95% CI 0.43 to 1.23; p = 0.234), major bleeding (RR 0.87; 95% CI 0.42 to 1.80; p = 0.705), and all-cause mortality (RR 1.05; 95% CI 0.79 to 1.39; p = 0.752). Compared with VKAs, rivaroxaban significantly reduced SSE events (RR 0.35; 95% CI 0.16 to 0.91; p = 0.029) and SE events (RR 0.39; 95% CI 0.16 to 0.95; p = 0.037). Conclusions: DOACs had a similar rate of thromboembolic and hemorrhagic events, as well as thrombus resolution, compared to VKAs in the treatment of LVTs. Rivaroxaban therapy had a significant reduction in thromboembolic events, compared to VKAs.
dc.description.issuenumber7
dc.description.volume121
dc.identifier.doi10.36660/abc.20230738i
dc.identifier.issnNone
dc.identifier.urihttps://dspace.mackenzie.br/handle/10899/39286
dc.relation.ispartofArquivos Brasileiros de Cardiologia
dc.rightsAcesso Aberto
dc.subject.otherlanguageFactor Xa Inhibitors
dc.subject.otherlanguageThrombosis
dc.subject.otherlanguageWarfarin
dc.titleDirect Oral Anticoagulants versus Vitamin K Antagonists for Left Ventricular Thrombus: A Meta-Analysis with Trial Sequential Analysis Anticoagulantes Orais Diretos versus Antagonistas da Vitamina K para Trombo Ventricular Esquerdo: Uma Metanálise com Análise Sequencial de Ensaios
dc.typeArtigo
local.scopus.citations0
local.scopus.eid2-s2.0-85200195434
local.scopus.subjectAdministration, Oral
local.scopus.subjectAnticoagulants
local.scopus.subjectHeart Diseases
local.scopus.subjectHeart Ventricles
local.scopus.subjectHemorrhage
local.scopus.subjectHumans
local.scopus.subjectRandomized Controlled Trials as Topic
local.scopus.subjectStroke
local.scopus.subjectThrombosis
local.scopus.subjectTreatment Outcome
local.scopus.subjectVitamin K
local.scopus.updated2024-10-01
local.scopus.urlhttps://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85200195434&origin=inward
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