Christos Gogos, Vasileios Anastasiou, Andreas S Papazoglou, Stylianos Daios, Matthaios Didagelos, Nikolaos Kamperidis, Vasileios Moschovidis, Spyridon Filippos Papadopoulos, Fotini Iatridi, Pantelis Sarafidis, George Giannakoulas, Vasileios Sachpekidis, Antonios Ziakas, Vasileios Kamperidis
{"title":"Direct Oral Anticoagulants versus Vitamin K Antagonists for the Management of Left Ventricular Thrombus after Myocardial Infarction: A Meta-analysis.","authors":"Christos Gogos, Vasileios Anastasiou, Andreas S Papazoglou, Stylianos Daios, Matthaios Didagelos, Nikolaos Kamperidis, Vasileios Moschovidis, Spyridon Filippos Papadopoulos, Fotini Iatridi, Pantelis Sarafidis, George Giannakoulas, Vasileios Sachpekidis, Antonios Ziakas, Vasileios Kamperidis","doi":"10.1016/j.amjcard.2024.09.008","DOIUrl":null,"url":null,"abstract":"<p><p>Left ventricular (LV) thrombus formation remains a post-acute myocardial infarction (AMI) complication even in the modern era of early reperfusion. The optimal anticoagulation regimen in this clinical scenario is poorly defined. The present meta-analysis sought to investigate the efficacy and safety profile of direct oral anticoagulants (DOACs) compared with Vitamin K antagonists (VKAs) for the management of LV thrombus following AMI. A systematic literature review was conducted in electronic databases to identify studies reporting efficacy and safety outcome data regarding the use of DOACs versus VKAs for patients with LV thrombus after AMI. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated and random-effects meta-analyses were conducted to synthesize pooled ORs. Eight studies comprising a total of 605 patients were included. DOACs were associated with an almost 2-fold higher likelihood of thrombus resolution compared to VKAs (pooled OR 1.95 [1.25-3.04]; p =0.003, I<sup>2</sup> =0 %), and decreased the risk of systemic embolism by 70% (pooled OR 0.30 [0.12-0.75]; p =0.01, I<sup>2</sup> =0 %). The use of DOACs was associated with a 54% lower risk of bleeding compared to VKAs (pooled OR 0.46 [0.26-0.84]; p =0.01, I<sup>2</sup> =0 %). Overall, patients receiving DOACs had a 63% lower risk to reach the composite outcome of safety and efficacy compared with patients using VKAs (pooled OR 0.37 [0.23-0.60]; p <0.0001, I<sup>2</sup> =0 %). In conclusion, DOACs appear to have a more favorable efficacy and safety profile compared to VKAs for the management of LV thrombus related to AMI.</p>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":null,"pages":null},"PeriodicalIF":2.3000,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"American Journal of Cardiology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.amjcard.2024.09.008","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
Abstract
Left ventricular (LV) thrombus formation remains a post-acute myocardial infarction (AMI) complication even in the modern era of early reperfusion. The optimal anticoagulation regimen in this clinical scenario is poorly defined. The present meta-analysis sought to investigate the efficacy and safety profile of direct oral anticoagulants (DOACs) compared with Vitamin K antagonists (VKAs) for the management of LV thrombus following AMI. A systematic literature review was conducted in electronic databases to identify studies reporting efficacy and safety outcome data regarding the use of DOACs versus VKAs for patients with LV thrombus after AMI. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated and random-effects meta-analyses were conducted to synthesize pooled ORs. Eight studies comprising a total of 605 patients were included. DOACs were associated with an almost 2-fold higher likelihood of thrombus resolution compared to VKAs (pooled OR 1.95 [1.25-3.04]; p =0.003, I2 =0 %), and decreased the risk of systemic embolism by 70% (pooled OR 0.30 [0.12-0.75]; p =0.01, I2 =0 %). The use of DOACs was associated with a 54% lower risk of bleeding compared to VKAs (pooled OR 0.46 [0.26-0.84]; p =0.01, I2 =0 %). Overall, patients receiving DOACs had a 63% lower risk to reach the composite outcome of safety and efficacy compared with patients using VKAs (pooled OR 0.37 [0.23-0.60]; p <0.0001, I2 =0 %). In conclusion, DOACs appear to have a more favorable efficacy and safety profile compared to VKAs for the management of LV thrombus related to AMI.
期刊介绍:
Published 24 times a year, The American Journal of Cardiology® is an independent journal designed for cardiovascular disease specialists and internists with a subspecialty in cardiology throughout the world. AJC is an independent, scientific, peer-reviewed journal of original articles that focus on the practical, clinical approach to the diagnosis and treatment of cardiovascular disease. AJC has one of the fastest acceptance to publication times in Cardiology. Features report on systemic hypertension, methodology, drugs, pacing, arrhythmia, preventive cardiology, congestive heart failure, valvular heart disease, congenital heart disease, and cardiomyopathy. Also included are editorials, readers'' comments, and symposia.