Khan Momina, Patel Kinnari, Edim Given E, Mazhar Maryam, Iram Hafiza Zanish, Chaudhari Sandipkumar S, Wei Calvin R, Khan Areeba
Acute Medicine, Heartlands Hospital, Birmingham, GBR.
Medicine, Sumy State University, La Mirada, USA.
Cureus. 2025 May 28;17(5):e84941. doi: 10.7759/cureus.84941. eCollection 2025 May.
Left ventricular thrombus (LVT) is a serious complication associated with myocardial infarction and cardiomyopathy. While vitamin K antagonists (VKAs) have been the standard treatment, direct oral anticoagulants (DOACs) offer potential advantages. This meta-analysis compares the efficacy and safety of DOACs versus VKAs in patients with LVT. We conducted a systematic search of PubMed, Excerpta Medica database (Embase), Scopus, Web of Science, and Cochrane Central Register of Controlled Trials (CENTRAL) from inception to April 2025. Studies comparing DOACs with VKAs in adult patients with LVT were included. The primary outcome was LVT resolution; secondary outcomes included stroke or systemic embolism (SSE) and bleeding events. Random-effects models were used to calculate pooled risk ratios (RRs) with 95% confidence intervals. Thirty-five studies (five RCTs and 30 observational) with 4,823 patients were included. LVT resolution was comparable between DOACs and VKAs (RR: 1.04, 95% CI: 0.99-1.10, I² = 30%). Risk of SSE showed no significant difference (RR: 0.91, 95% CI: 0.80-1.03, I² = 11%). DOACs were associated with significantly lower bleeding risk (RR: 0.87, 95% CI: 0.81-0.94, I² = 0%). Subgroup analyses by study design showed consistent findings. DOACs demonstrated comparable efficacy to VKAs for LVT resolution and stroke prevention while offering a superior safety profile with lower bleeding risk. These findings suggest DOACs may be a viable alternative to VKAs in LVT management, though large-scale randomized trials are needed to confirm these results and establish optimal dosing strategies.
左心室血栓（LVT）是与心肌梗死和心肌病相关的严重并发症。虽然维生素K拮抗剂（VKA）一直是标准治疗方法，但直接口服抗凝剂（DOAC）具有潜在优势。本荟萃分析比较了DOAC与VKA在LVT患者中的疗效和安全性。我们对PubMed、医学文摘数据库（Embase）、Scopus、科学网和Cochrane对照试验中央注册库（CENTRAL）进行了系统检索，检索时间从建库至2025年4月。纳入比较DOAC与VKA在成年LVT患者中的研究。主要结局是LVT溶解；次要结局包括中风或全身性栓塞（SSE）以及出血事件。采用随机效应模型计算合并风险比（RR）及95%置信区间。纳入了35项研究（5项随机对照试验和30项观察性研究），共4823例患者。DOAC与VKA在LVT溶解方面相当（RR：1.04，95%置信区间：0.99 - 1.10，I² = 30%）。SSE风险无显著差异（RR：0.91，95%置信区间：0.80 - 1.03，I² = 11%）。DOAC的出血风险显著更低（RR：0.87，95%置信区间：0.81 - 0.94，I² = 0%）。按研究设计进行的亚组分析显示结果一致。DOAC在LVT溶解和中风预防方面与VKA疗效相当，同时具有更好的安全性，出血风险更低。这些发现表明DOAC在LVT管理中可能是VKA的可行替代方案，不过仍需要大规模随机试验来证实这些结果并确定最佳给药策略。
