Dalia Tarun, Lahan Shubham, Ranka Sagar, Goyal Amandeep, Zoubek Sara, Gupta Kamal, Shah Zubair
Department of Cardiovascular Medicine, The University of Kansas Medical Center, Kansas City, Kansas, USA.
University College of Medical Sciences, New Delhi, India.
Thromb J. 2021 Feb 1;19(1):7. doi: 10.1186/s12959-021-00259-w.
Left ventricular thrombus (LVT) is not uncommon and pose a risk of systemic embolism, which can be mitigated by adequate anticoagulation. Direct oral anticoagulants (DOACs) are increasingly being used as alternatives to warfarin for anticoagulation, but their efficacy and safety profile has been debated. We aim to compare the therapeutic efficacy and safety of DOACs versus warfarin for the treatment of LVT.
We systematically searched PubMed/Medline, Google Scholar, Cochrane library, and LILCAS databases from inception to 14th August 2020 to identify relevant studies comparing warfarin and DOACs for LVT treatment and used the pooled data extracted from retrieved studies to perform a meta-analysis.
We report pooled data on 1955 patients from 8 studies, with a mean age of 61 years and 59.7 years in warfarin and DOACs group, respectively. The pooled odds ratio for thrombus resolution was 1.11 (95% CI 0.51-2.39) on comparing warfarin to DOAC, but it did not reach a statistical significance (p = 0.76). The pooled risk ratio (RR) of stroke or systemic embolization and bleeding in patients treated with warfarin vs DOACs was 1.04 (95% CI 0.64-1.68; p = 0.85), and 1.15 (95% CI 0.62-2.13; p = 0.57), respectively; with an overall RR of 1.09 (95% CI 0.70-1.70; p = 0.48) for mortality.
DOACs appears to be non-inferior or at least as effective as warfarin in the treatment of left ventricular thrombus without any statistical difference in stroke or bleeding complications.
左心室血栓（LVT）并不罕见，且存在全身栓塞风险，充分抗凝可降低该风险。直接口服抗凝剂（DOACs）越来越多地被用作华法林抗凝的替代药物，但其疗效和安全性一直存在争议。我们旨在比较DOACs和华法林治疗LVT的疗效和安全性。
我们系统检索了从创刊至2020年8月14日的PubMed/Medline、谷歌学术、考科蓝图书馆和LILCAS数据库，以识别比较华法林和DOACs治疗LVT的相关研究，并使用从检索到的研究中提取的汇总数据进行荟萃分析。
我们报告了来自8项研究的1955例患者的汇总数据，华法林组和DOACs组的平均年龄分别为61岁和59.7岁。比较华法林和DOAC时，血栓溶解的汇总比值比为1.11（95%CI 0.51-2.39），但未达到统计学显著性（p=0.76）。华法林与DOACs治疗患者的中风或全身栓塞及出血的汇总风险比（RR）分别为1.04（95%CI 0.64-1.68；p=0.85）和1.15（95%CI 0.62-2.13；p=0.57）；死亡率的总体RR为1.09（95%CI 0.70-1.70；p=0.48）。
在治疗左心室血栓方面，DOACs似乎不劣于华法林，或至少与华法林疗效相当，在中风或出血并发症方面无统计学差异。
