Efficacy and safety of direct oral anticoagulants versus vitamin K antagonists for left ventricular thrombus: a systematic review and meta-analysis
Khan, Momina Patel, Kinnari Edim, Given E Mazhar, Maryam Iram, Hafiza Zanish Chaudhari, Sandipkumar S Wei, Calvin R Khan, Areeba
Khan, Momina
Patel, Kinnari
Edim, Given E
Mazhar, Maryam
Iram, Hafiza Zanish
Chaudhari, Sandipkumar S
Wei, Calvin R
Khan, Areeba
Affiliation
University Hospitals Birmingham NHS Foundation Trust; Sumy State University; Raleigh General Hospital; Avalon University School of Medicine; Services Hospital Lahore; University of Alabama at Birmingham; University of North Dakota; Shing Huei Group; United Medical and Dental College Karachi
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Publication date
2025-05-28
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Abstract
Left ventricular thrombus (LVT) is a serious complication associated with myocardial infarction and cardiomyopathy. While vitamin K antagonists (VKAs) have been the standard treatment, direct oral anticoagulants (DOACs) offer potential advantages. This meta-analysis compares the efficacy and safety of DOACs versus VKAs in patients with LVT. We conducted a systematic search of PubMed, Excerpta Medica database (Embase), Scopus, Web of Science, and Cochrane Central Register of Controlled Trials (CENTRAL) from inception to April 2025. Studies comparing DOACs with VKAs in adult patients with LVT were included. The primary outcome was LVT resolution; secondary outcomes included stroke or systemic embolism (SSE) and bleeding events. Random-effects models were used to calculate pooled risk ratios (RRs) with 95% confidence intervals. Thirty-five studies (five RCTs and 30 observational) with 4,823 patients were included. LVT resolution was comparable between DOACs and VKAs (RR: 1.04, 95% CI: 0.99-1.10, I² = 30%). Risk of SSE showed no significant difference (RR: 0.91, 95% CI: 0.80-1.03, I² = 11%). DOACs were associated with significantly lower bleeding risk (RR: 0.87, 95% CI: 0.81-0.94, I² = 0%). Subgroup analyses by study design showed consistent findings. DOACs demonstrated comparable efficacy to VKAs for LVT resolution and stroke prevention while offering a superior safety profile with lower bleeding risk. These findings suggest DOACs may be a viable alternative to VKAs in LVT management, though large-scale randomized trials are needed to confirm these results and establish optimal dosing strategies.
Citation
Khan M, Patel K, Edim GE, Mazhar M, Iram HZ, Chaudhari SS, Wei CR, Khan A. Efficacy and Safety of Direct Oral Anticoagulants Versus Vitamin K Antagonists for Left Ventricular Thrombus: A Systematic Review and Meta-Analysis. Cureus. 2025 May 28;17(5):e84941. doi: 10.7759/cureus.84941.
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Article