评价直接口服抗凝剂与维生素 K 拮抗剂治疗左心室血栓的安全性和有效性：系统评价和荟萃分析。
Evaluation of the safety and efficacy of direct oral anticoagulants compared with vitamin-k antagonists in the treatment of left ventricular thrombosis. A systematic review and meta-analysis.
机构信息
Department of Cardiology, Imam Khomeini Hospital Complex of Tehran University of Medical Sciences, Tehran, Iran.
Department of Cardiology, Tehran Heart center, Tehran University of Medical Sciences, Tehran, Iran.
出版信息
Heart Lung. 2024 Sep-Oct;67:121-136. doi: 10.1016/j.hrtlng.2024.04.019. Epub 2024 May 15.
BACKGROUND
Since the introduction of direct oral anticoagulants (DOACs) and their comparison with vitamin K antagonists (VKAs), conflicting results have been reported regarding the optimal treatment for left ventricular thrombosis (LVT).
OBJECTIVES
In this meta-analysis, we intend to comprehensively evaluate the safety and efficacy of these treatments.
METHODS
All clinical trials and cohorts that compared the efficacy or safety of VKAs with DOACs in the treatment of LVTs were systematically searched until April 15, 2023.
RESULTS
The results of 32 studies with a pooled sample size of 4213 patients were extracted for meta-analysis. DOACs, especially rivaroxaban and apixaban, cause faster resolution, lower mortality, and fewer complications (SSE and bleeding events) than VKAs in the management of LVTs.
CONCLUSION
Compared with VKAs, DOACs result in significantly faster (only rivaroxaban) and safer resolution of left ventricular thrombosis.
背景
自直接口服抗凝剂（DOACs）问世并与维生素 K 拮抗剂（VKAs）进行比较以来，关于左心室血栓（LVT）的最佳治疗方法一直存在相互矛盾的结果。
目的
在这项荟萃分析中，我们旨在全面评估这些治疗方法的安全性和疗效。
方法
系统检索了截至 2023 年 4 月 15 日比较 VKAs 和 DOACs 治疗 LVT 疗效或安全性的所有临床试验和队列研究。
结果
共纳入 32 项研究，合并样本量为 4213 例患者，进行荟萃分析。与 VKAs 相比，DOACs，尤其是利伐沙班和阿哌沙班，在治疗 LVT 时能更快地（仅利伐沙班）溶解，死亡率更低，并发症（SSE 和出血事件）更少。
结论
与 VKAs 相比，DOACs 可更快（仅利伐沙班）且更安全地溶解左心室血栓。
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