Meta-analysis comparing direct oral anticoagulants versus vitamin K antagonists in patients with left ventricular thrombus.
Meta-analysis comparing direct oral anticoagulants versus vitamin K antagonists in patients with left ventricular thrombus.
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DOI：
10.1371/journal.pone.0252549
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发表时间：
2021
期刊：
影响因子：
3.7
通讯作者：
Hashiguchi M
中科院分区：
文献类型：
--
作者：
Kido K;Ghaffar YA;Lee JC;Bianco C;Shimizu M;Shiga T;Hashiguchi M
目前美国心脏病学会/美国心脏协会卒中或ST段抬高型心肌梗死指南建议使用口服维生素K拮抗剂（VKA）作为一线抗凝剂。尽管有几项研究比较了直接口服抗凝剂（DOAC）与VKA用于左心室血栓（LVT）抗凝治疗的情况，但这些研究的规模较小，并且产生了相互矛盾的结果。因此，进行这项荟萃分析是为了汇总这些研究，以更好地比较DOAC与VKA在LVT患者中的疗效和安全性。对截至2021年1月10日的科克伦图书馆、谷歌学术、MEDLINE和Web of Science数据库进行了检索。纳入了8项评估卒中或全身性栓塞（SSE）的研究，6项关于LVT消退的研究和5项关于出血的研究。DOAC和VKA（参考组）治疗之间的SSE（OR 0.89; 95% CI 0.46，1.71; p = 0.73; I2 = 45%）和LVT消退（OR 1.13; 95% CI 0.75，1.71; p = 0.56; I2 = 1%）无统计学显著差异。与VKA使用相比，DOAC使用与较低的出血事件发生率显著相关（OR 0.61; 95% CI 0.40，0.93; p = 0.02; I2 = 0%）。DOAC可能是治疗LV血栓的维生素K拮抗剂的可行替代抗凝剂。需要直接比较DOAC与VKA的随机对照试验。
Current American College of Cardiology/American Heart Association guidelines for stroke or ST-elevation myocardial infarction recommend the use of oral vitamin K antagonists (VKAs) as a first-line anticoagulant. Although several studies have compared the use of direct oral anticoagulants (DOACs) to VKAs for left ventricular thrombus (LVT) anticoagulation therapy, they are small scale and have produced conflicting results. Thus, this meta-analysis was performed to aggregate these studies to better compare the efficacy and safety of DOACs with VKAs in patients with LVT. Cochrane Library, Google Scholar, MEDLINE, and Web of Science database searches through January 10, 2021 were performed. Eight studies evaluating stroke or systemic embolism (SSE), six studies for LVT resolution, and five studies for bleeding were included. There were no statistically significant differences in SSE (OR 0.89; 95% CI 0.46, 1.71; p = 0.73; I2 = 45%) and LVT resolution (OR 1.13; 95% CI 0.75, 1.71; p = 0.56; I2 = 1%) between DOAC and VKA (reference group) therapy. DOAC use was significantly associated with lower bleeding event rates compared to VKA use (OR 0.61; 95% CI 0.40, 0.93; p = 0.02; I2 = 0%). DOACs may be feasible alternative anticoagulants to vitamin K antagonists for LV thrombus treatment. Randomized controlled trials directly comparing DOACs with VKAs are needed.
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DOI：
10.1093/ehjcvp/pvaa096
发表时间：
2021-09-01
影响因子：
7.1
作者：
Jones, Daniel A.;Wright, Paul;Antoniou, Sotiris
通讯作者：
Antoniou, Sotiris
影响因子：
3.3
作者：
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通讯作者：
Widimsky, Petr
影响因子：
3.5
作者：
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通讯作者：
Khalife, Wissam I.
影响因子：
37.8
作者：
MERLINI, PA;BAUER, KA;ROSENBERG, RD
通讯作者：
ROSENBERG, RD
影响因子：
3.1
作者：
Dalia T;Lahan S;Ranka S;Goyal A;Zoubek S;Gupta K;Shah Z
通讯作者：
Shah Z