Oral anticoagulation in patients with left ventricular thrombus: a systematic review and meta-analysis

source extracted confidence: high 2026-04-09
#humans #administration-oral #thrombosis #hemorrhage #treatment-outcome

Oral anticoagulation in patients with left ventricular thrombus: a systematic review and meta-analysis

Haller et al., 2024 | Eur Heart J Cardiovasc Pharmacother | Meta Analysis

Citation

Haller Paul M, Kazem Niema, ... Sulzgruber Patrick. Oral anticoagulation in patients with left ventricular thrombus: a systematic review and meta-analysis. Eur Heart J Cardiovasc Pharmacother. 2024-Aug-14;10(5):444-453. doi:10.1093/ehjcvp/pvae042

Abstract

AIMS: Direct oral anticoagulants (DOACs) are increasingly used off-label to treat patients with left ventricular thrombus (LVT). We analysed available meta-data comparing DOACs and vitamin K antagonists (VKAs) for efficacy and safety. METHODS: We conducted a systematic search and meta-analysis of observational and randomized data comparing DOACs vs. VKAs in patients with LVT. Endpoints of interest were stroke or systemic embolism, thrombus resolution, all-cause death, and a composite bleeding endpoint. Estimates were pooled using a random-effects model meta-analysis, and their robustness was investigated using sensitivity and influential analyses. RESULTS: We identified 22 articles (18 observational studies, 4 small randomized clinical trials) reporting on a total of 3587 patients (2489 VKA vs. 1098 DOAC therapy). The pooled estimates for stroke or systemic embolism [odds ratio (OR): 0.81; 95% confidence interval (CI): 0.57, 1.15] and thrombus resolution (OR: 1.12; 95% CI: 0.86, 1.46) were comparable, and there was low heterogeneity overall across the included studies. The use of DOACs was associated with lower odds of all-cause death (OR: 0.65; 95% CI: 0.46, 0.92) and a composite bleeding endpoint (OR: 0.67; 95% CI: 0.47, 0.97). A risk of bias was evident particularly for observational reports, with some publication bias suggested in funnel plots. CONCLUSION: In this comprehensive analysis of mainly observational data, the use of DOACs was not associated with a significant difference in stroke or systemic embolism, or thrombus resolution, compared with VKA therapy. The use of DOACs was associated with a lower rate of all-cause death and fewer bleeding events. Adequately sized randomized clinical trials are needed to confirm these findings, which could allow a wider adoption of DOACs in patients with LVT.

Key Findings

We identified 22 articles (18 observational studies, 4 small randomized clinical trials) reporting on a total of 3587 patients (2489 VKA vs. 1098 DOAC therapy). The pooled estimates for stroke or systemic embolism [odds ratio (OR): 0.81; 95% confidence interval (CI): 0.57, 1.15] and thrombus resolution (OR: 1.12; 95% CI: 0.86, 1.46) were comparable, and there was low heterogeneity overall across the included studies. The use of DOACs was associated with lower odds of all-cause death (OR: 0.65; 9

Outcomes Measured

  • Requires manual extraction

Population

Field Value
Population left ventricular thrombus
Sample Size 3587
Age Range See abstract
Condition See abstract

MeSH Terms

  • Humans
  • Administration, Oral
  • Thrombosis
  • Hemorrhage
  • Treatment Outcome
  • Risk Factors
  • Heart Diseases
  • Anticoagulants
  • Heart Ventricles
  • Female
  • Risk Assessment
  • Male
  • Stroke
  • Aged
  • Factor Xa Inhibitors
  • Vitamin K
  • Middle Aged

Evidence Classification

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

Provenance

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