直接口服抗凝剂与维生素K拮抗剂在左心室血栓治疗中的作用：一项荟萃分析与系统评价
The Role of Direct Oral Anticoagulants Versus Vitamin K Antagonists in the Treatment of Left Ventricular Thrombi: A Meta-Analysis and Systematic Review.
作者信息
Al-Abcha Abdullah, Herzallah Khader, Saleh Yehia, Mujer Mark, Abdelkarim Ola, Abdelnabi Mahmoud, Almaghraby Abdallah, Abela George S
机构信息
Department of Internal Medicine, Michigan State University, East Lansing, MI, USA.
Department of Cardiology, Tufts University, Boston, MA, USA.
出版信息
Am J Cardiovasc Drugs. 2021 Jul;21(4):435-441. doi: 10.1007/s40256-020-00458-2. Epub 2020 Dec 23.
BACKGROUND
Direct oral anticoagulants (DOACs) have a well-established role in the treatment of deep vein thrombosis and pulmonary embolism and in the reduction of thromboembolism in nonvalvular atrial fibrillation. However, limited evidence supports their role in patients with left ventricular thrombi.
METHODS
The PubMed, EMBASE, and Cochrane databases were searched for relevant articles published from inception to 1 August 2020. We included studies evaluating the effect of DOACs versus vitamin K antagonists (VKAs) in patients with left ventricular thrombi. The primary outcome was thrombus resolution, and the secondary outcomes were major bleeding and stroke or systemic embolization (SSE).
RESULTS
Five retrospective observational studies were included, with a total of 857 patients. VKAs and DOACs had a similar rate of thrombus resolution (odds ratio [OR] 0.97; 95% confidence interval [CI] 0.57-1.65; p = 0.90). Our analysis also demonstrated a similar rate of major bleeding (OR 0.62; 95% CI 0.27-1.44; p = 0.27) and SSE (OR 1.86; 95% CI 0.99-3.50; p = 0.05) between the two treatment groups.
CONCLUSION
In patients with left ventricular thrombi, DOACs and VKAs are associated with similar rates of thrombus resolution, major bleeding, and SSE.
背景
直接口服抗凝剂（DOACs）在治疗深静脉血栓形成和肺栓塞以及降低非瓣膜性心房颤动的血栓栓塞方面具有明确的作用。然而，支持其在左心室血栓患者中作用的证据有限。
方法
检索PubMed、EMBASE和Cochrane数据库，查找从数据库建立至2020年8月1日发表的相关文章。我们纳入了评估DOACs与维生素K拮抗剂（VKAs）对左心室血栓患者疗效的研究。主要结局是血栓溶解，次要结局是大出血、中风或全身性栓塞（SSE）。
结果
纳入了5项回顾性观察性研究，共857例患者。VKAs和DOACs的血栓溶解率相似（优势比[OR]0.97；95%置信区间[CI]0.57 - 1.65；p = 0.90）。我们的分析还表明，两个治疗组之间的大出血率（OR 0.62；95% CI 0.27 - 1.44；p = 0.27）和SSE率（OR 1.86；95% CI 0.99 - 3.50；p = 0.05）相似。
结论
在左心室血栓患者中，DOACs和VKAs的血栓溶解率、大出血率和SSE率相似。
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