The Role of Direct Oral Anticoagulants Versus Vitamin K Antagonists in the Treatment of Left Ventricular Thrombi: A Meta-Analysis and Systematic Review

source extracted confidence: high 2026-04-09
#anticoagulants #factor-xa-inhibitors #heart-ventricles #hemorrhage #humans

The Role of Direct Oral Anticoagulants Versus Vitamin K Antagonists in the Treatment of Left Ventricular Thrombi: A Meta-Analysis and Systematic Review

Al-Abcha et al., 2021 | Am J Cardiovasc Drugs | Meta Analysis

Citation

Al-Abcha Abdullah, Herzallah Khader, ... Abela George S. The Role of Direct Oral Anticoagulants Versus Vitamin K Antagonists in the Treatment of Left Ventricular Thrombi: A Meta-Analysis and Systematic Review. Am J Cardiovasc Drugs. 2021-Jul;21(4):435-441. doi:10.1007/s40256-020-00458-2

Abstract

BACKGROUND: Direct oral anticoagulants (DOACs) have a well-established role in the treatment of deep vein thrombosis and pulmonary embolism and in the reduction of thromboembolism in nonvalvular atrial fibrillation. However, limited evidence supports their role in patients with left ventricular thrombi. METHODS: The PubMed, EMBASE, and Cochrane databases were searched for relevant articles published from inception to 1 August 2020. We included studies evaluating the effect of DOACs versus vitamin K antagonists (VKAs) in patients with left ventricular thrombi. The primary outcome was thrombus resolution, and the secondary outcomes were major bleeding and stroke or systemic embolization (SSE). RESULTS: Five retrospective observational studies were included, with a total of 857 patients. VKAs and DOACs had a similar rate of thrombus resolution (odds ratio [OR] 0.97; 95% confidence interval [CI] 0.57-1.65; p = 0.90). Our analysis also demonstrated a similar rate of major bleeding (OR 0.62; 95% CI 0.27-1.44; p = 0.27) and SSE (OR 1.86; 95% CI 0.99-3.50; p = 0.05) between the two treatment groups. CONCLUSION: In patients with left ventricular thrombi, DOACs and VKAs are associated with similar rates of thrombus resolution, major bleeding, and SSE.

Key Findings

Five retrospective observational studies were included, with a total of 857 patients. VKAs and DOACs had a similar rate of thrombus resolution (odds ratio [OR] 0.97; 95% confidence interval [CI] 0.57-1.65; p = 0.90). Our analysis also demonstrated a similar rate of major bleeding (OR 0.62; 95% CI 0.27-1.44; p = 0.27) and SSE (OR 1.86; 95% CI 0.99-3.50; p = 0.05) between the two treatment groups.

Outcomes Measured

  • Requires manual extraction

Population

Field Value
Population left ventricular thrombi
Sample Size 857
Age Range See abstract
Condition See abstract

MeSH Terms

  • Anticoagulants
  • Factor Xa Inhibitors
  • Heart Ventricles
  • Hemorrhage
  • Humans
  • Observational Studies as Topic
  • Retrospective Studies
  • Thrombosis
  • Vitamin K

Evidence Classification

  • Level: Meta Analysis
  • Publication Types: Meta-Analysis, Systematic Review, Journal Article
  • Vertical: vitamin-k

Provenance

Source extracted via PubMed E-utilities API on 2026-04-09