Safety and Efficacy of Vitamin K Antagonists vs. Novel Oral Anticoagulants in Patients With Left Ventricular Thrombus: A Meta-Analysis.
Safety and Efficacy of Vitamin K Antagonists vs. Novel Oral Anticoagulants in Patients With Left Ventricular Thrombus: A Meta-Analysis.
复制标题
维生素 K 拮抗剂与新型口服抗凝剂在左心室血栓患者中的安全性和有效性
DOI：
10.3389/fcvm.2021.636491
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发表时间：
2021
影响因子：
3.6
通讯作者：
Zhou YF
中科院分区：
文献类型：
--
作者：
Xuan H;Chen YM;Dai YL;Zhou J;Jiang YF;Zhou YF
目标：进行了一项荟萃分析，以评价新型口服抗凝剂（NOAC）与维生素K拮抗剂（VKA）相比在左心室血栓（LVT）患者中的安全性和有效性。方法和结果：我们在PubMed、Web of Science和科克伦图书馆中检索了比较VKA与NOAC用于治疗LVT的队列研究，研究日期最早为2020年9月30日。预定的有效性和安全性结局包括血栓栓塞事件、LVT消退、临床显著性眼睑下垂和全因死亡。使用固定效应模型估计合并效应。进行了发表偏倚分析和敏感性分析，以检查结果的稳健性。共纳入6项研究，招募了837名患者（平均年龄60.2 ± 1.6岁; 77.2%为男性）。我们发现血栓栓塞事件[相对风险（RR）1.69，95%置信区间（CI）0.94-3.06，P 0.08，I2 12.7%]、血栓消退率（RR 1.08，95% CI 0.96-1.21，P 0.21，I2 4.8%）和具有临床意义的眼睑下垂（RR 0.70，95% CI 0.37-1.32，P 0.27，I2 0%）。此外，两组之间的全因死亡率无显著差异（RR 1.24，95% CI 0.79-1.96，P 0.35，I2 0.0%）。敏感性分析，使用“1-研究删除”的方法，没有发现显着差异。结论：NOAC和VKA在治疗LVT方面具有相似的疗效和安全性，因此推断NOAC是LVT治疗中VKA的可能替代品。
Aims: A meta-analysis was conducted to evaluate the safety and efficacy of novel oral anticoagulants (NOACs) compared with vitamin K antagonists (VKAs) in patients with left ventricular thrombus (LVT). Methods and Results: We searched PubMed, Web of Science, and Cochrane Library for cohort studies comparing the use of VKAs vs. NOACs for the treatment of LVT from the earliest date available to September 30, 2020. The predetermined efficacy and safety outcomes included thromboembolic events, resolution of LVT, clinically significant bleedings, and all-cause death. Fixed-effects model was used to estimate the pooled effects. Publication bias analyses and sensitivity analyses were conducted to check the robustness of results. A total of 6 studies enrolling 837 patients (mean age 60.2 ± 1.6 years; 77.2% were male) were included. We found no significant differences in thromboembolic events [relative risk (RR) 1.69, 95% confidence interval (CI) 0.94–3.06, P 0.08, I2 12.7%], the rate of resolution of thrombus (RR 1.08, 95% CI 0.96–1.21, P 0.21, I2 4.8%), and clinically significant bleedings (RR 0.70, 95% CI 0.37–1.32, P 0.27, I2 0%) between the VKAs and NOACs group. Additionally, no significant difference in all-cause mortality was found between the two groups (RR 1.24, 95% CI 0.79–1.96, P 0.35, I2 0.0%). Sensitivity analyses, using the “1-study removed” method, detected no significant differences. Conclusion: NOACs and VKAs have similar efficacy and safety in treating LVT, prompting the inference that NOACs are the possible alternatives of VKAs in LVT therapy.