Direct Oral Anticoagulants Versus Vitamin K Antagonists for the Management of Left Ventricular Thrombus After Myocardial Infarction: A Meta-Analysis.

Autor: Gogos C; 1st Department of Cardiology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece., Anastasiou V; 1st Department of Cardiology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece., Papazoglou AS; Athens Naval Hospital, Greece., Daios S; 1st Department of Cardiology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece., Didagelos M; 1st Department of Cardiology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece., Kamperidis N; Department of IBD, St Mark's Hospital, Imperial College London, London UK., Moschovidis V; Department of Cardiology, Papageorgiou Hospital, Thessaloniki, Greece., Papadopoulos SF; 1st Department of Cardiology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece., Iatridi F; Department of Nephrology, Hippokration Hospital, School of Medicine, Aristotle University of Thessaloniki, Greece., Sarafidis P; Department of Nephrology, Hippokration Hospital, School of Medicine, Aristotle University of Thessaloniki, Greece., Giannakoulas G; 1st Department of Cardiology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece., Sachpekidis V; Department of Cardiology, Papageorgiou Hospital, Thessaloniki, Greece., Ziakas A; 1st Department of Cardiology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece., Kamperidis V; 1st Department of Cardiology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece. Electronic address: vkamperidis@outlook.com.
Jazyk: angličtina
Zdroj: The American journal of cardiology [Am J Cardiol] 2024 Dec 01; Vol. 232, pp. 18-25. Date of Electronic Publication: 2024 Sep 11.
DOI: 10.1016/j.amjcard.2024.09.008
Abstrakt: 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 after 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 twofold higher likelihood of thrombus resolution compared with VKAs (pooled OR 1.95 [1.25 to 3.04], p = 0.003, I 2 = 0%), and decreased the risk of systemic embolism by 70% (pooled OR 0.30 [0.12 to 0.75]; p = 0.01, I 2 = 0%). The use of DOACs was associated with a 54% lower risk of bleeding compared with VKAs (pooled OR 0.46 [0.26 to 0.84], p = 0.01, I 2 = 0%). Overall, patients receiving DOACs had a 63% lower risk of reaching the composite outcome of safety and efficacy compared with patients using VKAs (pooled OR 0.37 [0.23 to 0.60], p <0.0001, I 2 = 0%). In conclusion, DOACs appear to have a more favorable efficacy and safety profile compared with VKAs for the management of LV thrombus related to AMI.
Competing Interests: Declaration of competing interest The authors have no competing interests to declare.
(Copyright © 2024 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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