TY - JOUR T1 - Effect of direct oral anticoagulants versus vitamin K antagonists or warfarin in patients with left ventricular thrombus outcomes: A systematic review and meta-analysis JO - Revista Portuguesa de Cardiologia T2 - AU - da Silva Ferreira,Hilaryano AU - Lima Lopes,Joana AU - Augusto,João AU - Simões,Joana AU - Roque,David AU - Faria,Daniel AU - Ferreira,João AU - Fialho,Inês AU - Beringuilho,Marco AU - Morais,Humberto AU - Ferreira,Ana Rita AU - Morais,José AU - Morais,Carlos SN - 08702551 M3 - 10.1016/j.repc.2021.11.013 DO - 10.1016/j.repc.2021.11.013 UR - https://www.revportcardiol.org/pt-effect-direct-oral-anticoagulants-versus-articulo-S0870255122004796 AB - IntroductionLeft 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. AimTo 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). MethodsA 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. ResultsFourteen 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%). ConclusionsThe findings of this meta-analysis suggest the potential utility of DOACs as a first-line strategy in patients with left ventricular thrombus. ER -