Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, China.
Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, China.
ESC Heart Fail. 2022 Oct;9(5):3519-3532. doi: 10.1002/ehf2.14084. Epub 2022 Jul 27.
Left ventricular thrombus (LVT) increases the risk of thrombotic events and mortality. Vitamin K antagonists (VKAs) used to treat LVT have several known risks, as a result of which direct oral anticoagulant (DOAC) use has recently increased. We aimed to evaluate the safety and efficacy of DOACs and VKAs in treating LVT.
We searched PubMed, Embase, Cochrane Library trials, and Web of Science databases for studies published before 19 April 2022, involving DOAC versus VKA treatment for patients with LVT. This meta-analysis comprised 21 studies (total patients, n = 3172; DOAC group, n = 888; VKA group, n = 2284). A statistically significant reduction in bleeding events was observed in patients on DOACs vs. those on VKAs (risk ratio (RR) = 0.73, P = 0.004). Patients on DOACs residing in North American and European regions and those with ischaemic heart disease (IHD) had a significantly lower risk of bleeding events than patients residing in other regions or those with a different LVT aetiology, respectively (RR = 0.78, P = 0.04; RR = 0.38, P = 0.02; and RR = 0.63, P = 0.009). A statistically significant reduction in stroke in patients on DOACs versus VKAs (RR = 0.72, P = 0.03) was observed, and patients on DOACs residing in North America and those with IHD had a significantly lower risk of stroke (RR = 0.73, P = 0.04, and RR = 0.61, P = 0.03, respectively). Compared with VKAs, DOACs are statistically associated with an increase in LVT resolution at 1 month (RR = 1.96, P = 0.008). No statistical between-group difference in all-cause mortality (RR = 0.72, P = 0.05), systemic embolism (RR = 0.87, P = 0.74), stroke or systemic embolism (RR = 0.90, P = 0.50), and LVT resolution at the end of follow-up (RR = 1.06, P = 0.13) was observed.
Compared with VKAs, DOACs significantly reduce the risk of bleeding events and stroke in LVT patients, but mortality was similar in both groups. The advantages are apparent not only in patients belonging to the predominantly white residential areas such as North American and European regions but also in patients with LVT due to IHD. DOACs show promising effects in treating LVT compared with VKAs.
左心室血栓（LVT）会增加血栓事件和死亡的风险。用于治疗 LVT 的维生素 K 拮抗剂（VKA）有几个已知的风险，因此最近直接口服抗凝剂（DOAC）的使用有所增加。我们旨在评估 DOAC 和 VKA 在治疗 LVT 中的安全性和疗效。
我们在 PubMed、Embase、Cochrane 图书馆试验和 Web of Science 数据库中搜索了截至 2022 年 4 月 19 日发表的研究，涉及 DOAC 与 VKA 治疗 LVT 患者的比较。这项荟萃分析纳入了 21 项研究（总患者数 n=3172；DOAC 组 n=888；VKA 组 n=2284）。与 VKA 相比，DOAC 组患者出血事件的发生率显著降低（风险比 RR=0.73，P=0.004）。与居住在其他地区或 LVT 病因不同的患者相比，居住在北美和欧洲地区以及患有缺血性心脏病（IHD）的 DOAC 组患者出血事件的风险显著降低（RR=0.78，P=0.04；RR=0.38，P=0.02；和 RR=0.63，P=0.009）。与 VKA 相比，DOAC 组患者的卒中发生率显著降低（RR=0.72，P=0.03），且居住在北美的 DOAC 组患者和患有 IHD 的患者卒中风险显著降低（RR=0.73，P=0.04；RR=0.61，P=0.03）。与 VKA 相比，DOAC 在 1 个月时 LVT 消退的比例显著增加（RR=1.96，P=0.008）。两组间全因死亡率（RR=0.72，P=0.05）、系统性栓塞（RR=0.87，P=0.74）、卒中或系统性栓塞（RR=0.90，P=0.50）和随访结束时 LVT 消退的比例（RR=1.06，P=0.13）无统计学差异。
与 VKA 相比，DOAC 可显著降低 LVT 患者出血事件和卒中的风险，但两组间死亡率相似。这种优势不仅在北美和欧洲等白人主要居住地区的患者中明显，而且在缺血性心脏病引起的 LVT 患者中也明显。与 VKA 相比，DOAC 在治疗 LVT 方面显示出有前景的效果。
