Cheng Yun-Yung, Tan Shennie, Hong Chien-Tai, Yang Cheng-Chang, Chan Lung
Department of Neurology, Shuang-Ho Hospital, Taipei Medical University, New Taipei 235, Taiwan.
Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 235, Taiwan.
J Cardiovasc Dev Dis. 2022 Oct 13;9(10):351. doi: 10.3390/jcdd9100351.
Left atrial appendage thrombus (LAAT) is the main cause of cardioembolism in patients with nonvalvular atrial fibrillation (AF). Emerging evidence indicates that direct oral anticoagulants (DOACs) may be a preferred, safer choice for patients with LAAT. However, current guidelines indicate vitamin K antagonist (VKA) as the preferred treatment for LAAT. We conducted a meta-analysis to compare the efficacy of VKA and DOAC for the treatment of LAAT. The search was conducted in the PubMed, Embase, Google Scholar, and Cochrane Library databases from inception to July 2022, with the language restricted to English. A first analysis was conducted to evaluate the risk of LAAT under VKA or DOAC treatment. A second analysis was conducted to compare the resolution of LAAT under VKA and DOAC treatment. In 13 studies comparing LAAT incidence rates under VKA and DOAC treatment, significant superiority of DOAC was detected (pooled RR = 0.65, 95% CI = 0.47-0.90, = 0.009) with moderate heterogeneity being identified in the pooled studies. In 13 studies comparing LAAT resolution under VKA and DOAC use, treatment with DOAC exhibited a significantly increased probability of LAAT resolution compared with VKA (pooled odds ratio = 1.52, 95% CI = 1.02-2.26, = 0.040). This meta-analysis suggests a superiority of DOAC over VKA with respect to LAAT incidence in people with AF and the likelihood of LAAT resolution. Due to their established safety profile, DOAC is a preferable choice for anticoagulation, although further randomized controlled studies are warranted to provide further evidence of their suitability as a new recommended treatment.
左心耳血栓（LAAT）是非瓣膜性心房颤动（AF）患者发生心脏栓塞的主要原因。新出现的证据表明，直接口服抗凝剂（DOACs）可能是LAAT患者更优、更安全的选择。然而，目前的指南将维生素K拮抗剂（VKA）作为LAAT的首选治疗方法。我们进行了一项荟萃分析，以比较VKA和DOAC治疗LAAT的疗效。检索在PubMed、Embase、谷歌学术和Cochrane图书馆数据库中进行，时间跨度从建库至2022年7月，语言限制为英语。首次分析旨在评估VKA或DOAC治疗下LAAT的风险。第二次分析旨在比较VKA和DOAC治疗下LAAT的溶解情况。在13项比较VKA和DOAC治疗下LAAT发生率的研究中，检测到DOAC具有显著优势（合并相对危险度=0.65，95%置信区间=0.47-0.90，P=0.009），且在合并研究中发现存在中度异质性。在13项比较使用VKA和DOAC时LAAT溶解情况的研究中，与VKA相比，DOAC治疗使LAAT溶解的概率显著增加（合并比值比=1.52，95%置信区间=1.02-2.26，P=0.040）。这项荟萃分析表明，在AF患者中，就LAAT发生率和LAAT溶解可能性而言，DOAC优于VKA。鉴于DOAC已确立的安全性，它是抗凝治疗的更优选择，尽管仍需进一步的随机对照研究来提供更多证据证明其作为新推荐治疗方法的适用性。
