Division of Cardiology, Department of Medicine, University of Iowa, 200 Hawkins Dr, E 315GH, Iowa City, IA 52242, USA.
Department of Internal Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA.
Curr Probl Cardiol. 2024 Dec;49(12):102871. doi: 10.1016/j.cpcardiol.2024.102871. Epub 2024 Oct 5.
The management of anticoagulation in patients with durable left ventricular assist devices (LVADs) is challenging. Traditionally, warfarin has been used, but its limitations have prompted interest in direct oral anticoagulants (DOACs). This meta-analysis aims to evaluate the safety and efficacy of DOACs compared to warfarin in LVAD patients.
We searched databases for studies comparing DOACs and warfarin in LVAD patients. Primary outcomes were thromboembolic events and major bleeding events. Secondary outcomes were the individual components of the thromboembolic events, minor bleeding events, and all-cause mortality. Random-effects model was used to calculate log risk-ratios (RR) with 95 % confidence intervals (CI).
Nine studies with a total of 316 LVAD patients (153 on DOACs, 163 on warfarin) were included. Thromboembolic events were similar between the groups (Log RR -0.42, 95 % CI:1.29 to 0.45, P = 0.34). Major bleeding events were significantly fewer in the DOAC group (Log RR -1.05, 95 % CI:1.73 to -0.36, P < 0.01). Minor bleeding events were also less common with DOACs (Log RR -0.77, 95 % CI:1.46 to -0.07, P = 0.03). No significant differences were observed in pump thrombosis, ischemic cerebrovascular accident events, or all-cause mortality.
DOACs appear to be a safe and effective alternative to warfarin for anticoagulation in LVAD patients, associated with fewer major and minor bleeding events. These findings support the consideration of DOACs in this patient population, though further research is needed to confirm these results and guide clinical practice.
在使用耐用性左心室辅助装置（LVAD）的患者中，抗凝管理颇具挑战性。传统上，华法林一直被使用，但由于其局限性，人们对直接口服抗凝剂（DOAC）产生了兴趣。本荟萃分析旨在评估与华法林相比，DOAC 在 LVAD 患者中的安全性和疗效。
我们在数据库中检索了比较 LVAD 患者中 DOAC 和华法林的研究。主要结局是血栓栓塞事件和大出血事件。次要结局是血栓栓塞事件、轻微出血事件和全因死亡率的各个组成部分。使用随机效应模型计算对数风险比（RR）及其 95%置信区间（CI）。
共纳入 9 项研究，总计 316 例 LVAD 患者（153 例接受 DOAC 治疗，163 例接受华法林治疗）。两组之间血栓栓塞事件相似（对数 RR -0.42，95%CI：1.29 至 0.45，P = 0.34）。DOAC 组大出血事件明显减少（对数 RR -1.05，95%CI：1.73 至 -0.36，P < 0.01）。DOAC 也较少发生轻微出血事件（对数 RR -0.77，95%CI：1.46 至 -0.07，P = 0.03）。两组在泵血栓形成、缺血性脑血管意外事件或全因死亡率方面无显著差异。
DOAC 似乎是 LVAD 患者抗凝治疗的一种安全有效替代方案，与较少的大出血和轻微出血事件相关。这些发现支持在这一患者群体中考虑使用 DOAC，但需要进一步的研究来证实这些结果并指导临床实践。
