Effect of direct oral anticoagulants versus vitamin K antagonists or warfarin in patients with left ventricular thrombus outcomes: A systematic review and meta-analysis

Left ventricular thrombus commonly occurs as a complication of acute anterior myocardial infarction and nonischemic cardiomyopathies with severe left ventricular systolic dysfunction. Its frequency is still high despite medical advances. Current guidelines recommend the use of vitamin k antagonists as first-line therapy, however, the off-label use of direct oral anticoagulants is becoming more frequent and attractive, given the better pharmacological and clinical profile, with the improvement of the patient's quality of life. To provide an update on the currently existing evidence regarding the outcomes of efficacy and safety of direct oral anticoagulants (DOACs) as first-line therapy in left ventricular thrombus, in comparison to vitamin K antagonists (VKAs). A systematic review and meta-analysis of studies on the effects of direct oral anticoagulants versus vitamin K antagonists on left ventricular thrombi and on the results was performed. Fourteen studies were included in the meta-analysis, with a total of 2498 patients (n=631 direct oral anticoagulants and n=1867 for VKAs). No significant differences were found in efficacy and safety outcomes (odds ratio (OR) 0.86; 95% confidence interval (CI), 0.55–1.33; p=0.50; I2=32%) and (OR 1.0; 95% CI, 0.78–1.30; p=0.93; I2=2%) respectively. No difference was noted in all-cause mortality (OR 0.92; 95% CI, 0.58–1.45; p=0.74; I2=0%). Thrombus resolution was observed in 288/416 in direct oral anticoagulants vs. 732/1085 patients treated with VKAs (OR 1.14; 95% CI, 0.77–1.66; p=0.50; I2=33%). The findings of this meta-analysis suggest the potential utility of DOACs as a first-line strategy in patients with left ventricular thrombus. Trombos no ventrículo esquerdo ocorrem geralmente como complicação do enfarte agudo do miocárdio anterior e de cardiomiopatias não isquémicas com disfunção sistólica ventricular esquerda grave. A sua frequência ainda é alta, apesar dos avanços médicos. As orientações atuais recomendam o uso de antagonistas da vitamina K como tratamento de primeira linha. No entanto, a utilização de anticoagulantes orais diretos está a tornar-se mais frequente, dado o melhor perfil farmacológico e clínico, com melhoria da qualidade de vida do doente. Atualizar a evidência existente relativamente à eficácia e segurança dos anticoagulantes orais diretos como tratamento de primeira linha no TVE, em comparação com os antagonistas da vitamina K. Foi realizada uma revisão sistemática e uma meta-análise de estudo