DOACs effective alternative to Vitamin K Antagonists for LV thrombus: Study

Oral anticoagulation is effective in the prevention of ischemic stroke and systemic embolism in patients with atrial fibrillation (AF). Vitamin K antagonists (VKAs) inhibiting the production of several coagulation factors in the liver have been the only option for long‐term oral anticoagulation for many years. Direct oral anticoagulants (DOACs) including the thrombin inhibitor, dabigatran, and the factor Xa inhibitors, apixaban, edoxaban, and rivaroxaban, have been proven to be at least as effective in preventing ischemic stroke and systemic embolism in patients with AF while having a lower risk of symptomatic intracranial hemorrhage.

Though current guidelines currently recommend using warfarin, there is also a growing interest in the utilization of direct oral anticoagulants (DOACs) to treat left ventricular (LV) thrombus.

For the study design, Researchers performed a systematic search using PubMed, SCOPUS, EMBASE, Google Scholar, and ClinicalTrials.gov from inception to September 30, 2020, for studies that had reported outcomes in patients with left ventricular thrombus treated with DOACs (PROSPERO registration number CRD42020219761).

Data analysis revealed some interesting facts.

• Twelve studies (n = 867 patients) were included in the analysis.
• The pooled incidence of the systemic embolic events (SEE) with DOACs was 2.7%, whereas the thrombus resolution rate was 86.6%.
• The pooled incidence of overall bleeding (composite of major and minor bleeding) and major bleeding with DOACs were 5.6% and 1.1%, respectively.
• No significant difference was observed in terms of SEE (OR 0.81, 95% confidence interval [CI] 0.44–1.52, p = .54), major bleeding (OR 0.29, 95% CI 0.07–1.26, p = .24), and failure of LV thrombus resolution (OR 0.86, 95% CI 0.28–2.58, p = .68); whereas overall bleeding was significantly low in patients with LV thrombus treated with DOACs compared to vitamin K antagonists (VKAs) (OR 0.33, 95% CI 0.14–0.81, p = .02).

"However, further well‐designed prospective trials are needed to answer important clinical questions—optimal dosing/duration of DOACs and its safety in the background of antiplatelet therapy."the research team concluded.

For the full article follow the link: https://doi.org/10.1111/jce.15016

Primary source:Journal of Cardiovascular Electrophysiology.