Department of Medicine, 3989Baylor College of Medicine, Houston, TX, USA.
Section of Cardiology, Department of Medicine, 3989Baylor College of Medicine, Houston, TX, USA.
J Cardiovasc Pharmacol Ther. 2021 Mar;26(2):173-178. doi: 10.1177/1074248420967644. Epub 2020 Oct 20.
To compare the safety and efficacy of direct oral anticoagulants (DOAC) relative to vitamin K antagonists (VKA) for the treatment of left ventricular thrombus (LVT).
This retrospective study enrolled patients diagnosed with LVT from 2014-2017. Patient characteristics and outcomes within 12 months of LVT diagnosis were recorded and analyzed. A meta-analysis was also performed by pooling our results with existing data in literature.
14 DOAC and 59 VKA patients were included. Baseline demographic and clinical characteristics were similar except for age. Although more strokes within 12 months occurred in VKA (15%) than in DOAC (0%) patients, this was not statistically significant ( = 0.189). There were no significant differences in outcomes between patients on DOAC and VKA for acute coronary syndrome (ACS) (7%, vs 3.4%, = .477), LVT resolution (86% vs 76%, = .499) or bleeding (14% vs 14%, = 1) within 12 months. The meta-analysis included 6 studies (n = 408 for DOACs; n = 1207 for VKA). There were no significant differences between DOACs versus VKAs with respect to odds for unresolved thrombus (OR 0.61, 95% CI 0.26,1.41), embolic events (OR 1.24, 95% CI 0.90,1.69), embolic events and death (OR 1.10, 95% CI 0.84,1.45) or bleeding events (OR 1.13, 95% CI 0.74,1.72).
Our study and meta-analysis suggest similar efficacy and safety of DOACs in the treatment of LVT compared to VKA. These findings underscore the need for a randomized controlled trial.
比较直接口服抗凝剂（DOAC）与维生素 K 拮抗剂（VKA）治疗左心室血栓（LVT）的安全性和疗效。
本回顾性研究纳入了 2014 年至 2017 年期间诊断为 LVT 的患者。记录并分析了 LVT 诊断后 12 个月内的患者特征和结局。还通过汇总我们的结果和文献中的现有数据进行了荟萃分析。
共纳入 14 例 DOAC 和 59 例 VKA 患者。除年龄外，基线人口统计学和临床特征相似。尽管 VKA 组（15%）在 12 个月内发生中风的患者多于 DOAC 组（0%），但差异无统计学意义（ = 0.189）。DOAC 组和 VKA 组在急性冠脉综合征（ACS）（7%，vs. 3.4%， =.477）、LVT 消退（86%，vs. 76%， =.499）或出血（14%，vs. 14%， = 1）方面，12 个月内的结局无显著差异。荟萃分析纳入了 6 项研究（n = 408 例 DOAC；n = 1207 例 VKA）。在未解决血栓形成的几率（OR 0.61，95%CI 0.26，1.41）、栓塞事件（OR 1.24，95%CI 0.90，1.69）、栓塞事件和死亡（OR 1.10，95%CI 0.84，1.45）或出血事件（OR 1.13，95%CI 0.74，1.72）方面，DOAC 与 VKA 之间无显著差异。
我们的研究和荟萃分析表明，与 VKA 相比，DOAC 在治疗 LVT 方面具有相似的疗效和安全性。这些发现强调了需要进行随机对照试验。
