Warfarin versus direct oral anticoagulants for treating left ventricular thrombus: a systematic review and meta-analysis.
Warfarin versus direct oral anticoagulants for treating left ventricular thrombus: a systematic review and meta-analysis.
复制标题
DOI：
10.1186/s12959-021-00259-w
复制
发表时间：
2021-02-01
影响因子：
3.1
通讯作者：
Shah Z
中科院分区：
文献类型：
--
作者：
Dalia T;Lahan S;Ranka S;Goyal A;Zoubek S;Gupta K;Shah Z
左心室血栓（LVT）并不罕见，并造成全身栓塞的风险，这可以通过适当的抗凝来减轻。直接口服抗凝剂（DOACs）越来越多地被用作华法林抗凝的替代品，但其有效性和安全性一直存在争议。我们的目的是比较DOACs与华法林治疗LVT的疗效和安全性。我们系统地检索了PubMed/Medline、谷歌Scholar、Cochrane library和LILCAS数据库，从建立到2020年8月14日，以确定比较华法林和DOACs治疗LVT的相关研究，并使用从检索到的研究中提取的汇总数据进行荟萃分析。我们汇总了来自8项研究的1955例患者的数据，华法林组和DOACs组的平均年龄分别为61岁和59.7岁。华法林与DOAC比较，血栓溶解的合并优势比为1.11 (95% CI 0.51-2.39)，但没有达到统计学意义（p = 0.76）。华法林治疗与DOACs治疗患者卒中或全系统栓塞出血的合并风险比（RR）分别为1.04 （95% CI 0.64-1.68; p = 0.85）和1.15 (95% CI 0.62-2.13; p = 0.57)；死亡率的总体RR为1.09 （95% CI 0.70-1.70; p = 0.48）。DOACs在治疗左心室血栓方面不逊色，或至少与华法林一样有效，在卒中或出血并发症方面没有统计学差异。在线版本包含补充材料，可在10.1186/s12959-021-00259-w获得。
Left ventricular thrombus (LVT) is not uncommon and pose a risk of systemic embolism, which can be mitigated by adequate anticoagulation. Direct oral anticoagulants (DOACs) are increasingly being used as alternatives to warfarin for anticoagulation, but their efficacy and safety profile has been debated. We aim to compare the therapeutic efficacy and safety of DOACs versus warfarin for the treatment of LVT. We systematically searched PubMed/Medline, Google Scholar, Cochrane library, and LILCAS databases from inception to 14th August 2020 to identify relevant studies comparing warfarin and DOACs for LVT treatment and used the pooled data extracted from retrieved studies to perform a meta-analysis. We report pooled data on 1955 patients from 8 studies, with a mean age of 61 years and 59.7 years in warfarin and DOACs group, respectively. The pooled odds ratio for thrombus resolution was 1.11 (95% CI 0.51–2.39) on comparing warfarin to DOAC, but it did not reach a statistical significance (p = 0.76). The pooled risk ratio (RR) of stroke or systemic embolization and bleeding in patients treated with warfarin vs DOACs was 1.04 (95% CI 0.64–1.68; p = 0.85), and 1.15 (95% CI 0.62–2.13; p = 0.57), respectively; with an overall RR of 1.09 (95% CI 0.70–1.70; p = 0.48) for mortality. DOACs appears to be non-inferior or at least as effective as warfarin in the treatment of left ventricular thrombus without any statistical difference in stroke or bleeding complications. The online version contains supplementary material available at 10.1186/s12959-021-00259-w.
登录
查看更多内容
影响因子：
2.8
作者：
Gianstefani, Silvia;Douiri, Abdel;MacCarthy, Philip
通讯作者：
MacCarthy, Philip
影响因子：
3.3
作者：
Delewi, Ronak;Nijveldt, Robin;Piek, Jan J.
通讯作者：
Piek, Jan J.
影响因子：
3.3
作者：
Ibanez, Borja;James, Stefan;Widimsky, Petr
通讯作者：
Widimsky, Petr
影响因子：
24
作者：
Lattuca, Benoit;Bouziri, Nesrine;Silvain, Johanne
通讯作者：
Silvain, Johanne
影响因子：
37.8
作者：
Ottervanger, JP;Armstrong, P;Simoons, ML
通讯作者：
Simoons, ML