{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T06:58:03Z","timestamp":1789109883658,"version":"build-2803163510"},"reference-count":47,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2024,6,6]],"date-time":"2024-06-06T00:00:00Z","timestamp":1717632000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,8,14]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Aims<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ehjcvp\/pvae042","type":"journal-article","created":{"date-parts":[[2024,6,7]],"date-time":"2024-06-07T07:38:04Z","timestamp":1717745884000},"page":"444-453","source":"Crossref","is-referenced-by-count":18,"title":["Oral anticoagulation in patients with left ventricular thrombus: a systematic review and meta-analysis"],"prefix":"10.1093","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7714-4446","authenticated-orcid":false,"given":"Paul M","family":"Haller","sequence":"first","affiliation":[{"name":"Department of Cardiology, University Heart and Vascular Center Hamburg , Building O50, Empore, Martinistrasse 52, 20246 Hamburg , Germany"},{"name":"German Center for Cardiovascular Research (DZHK), Partner Site Hamburg\/Kiel\/L\u00fcbeck , Hamburg 20246 , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6368-4580","authenticated-orcid":false,"given":"Niema","family":"Kazem","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna , W\u00e4hringer G\u00fcrtel 18-20, 1090 Vienna , Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Agewall","sequence":"additional","affiliation":[{"name":"Division of Clinical Science, Danderyd hospital, Karolinska Institute, Stockholm 171 77 , Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8039-8781","authenticated-orcid":false,"given":"Claudio","family":"Borghi","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences, University of Bologna, IRCCS Azienda Ospedaliero-Universitaria di Bologna, \u00a0 Bologna 40126 , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudio","family":"Ceconi","sequence":"additional","affiliation":[{"name":"Cardiovascular Institute, Azienda Ospedaliera Universitaria S. Anna , Ferrara 44124 , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4612-117X","authenticated-orcid":false,"given":"Dobromir","family":"Dobrev","sequence":"additional","affiliation":[{"name":"Institute of Pharmacology, West German Heart and Vascular Center, University Duisburg-Essen , Essen 45122 , Germany"},{"name":"Montr\u00e9al Heart Institute, Universit\u00e9 de Montr\u00e9al , Montr\u00e9al, Qu\u00e9bec H1T 1C8 , Canada"},{"name":"Department of Integrative Physiology, Baylor College of Medicine , Houston, TX 77030 , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7839-1361","authenticated-orcid":false,"given":"Elisabetta","family":"Cerbai","sequence":"additional","affiliation":[{"name":"Department of Preclinical and Clinical Pharmacology, University of Florence , Florence 50121 , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erik Lerkevang","family":"Grove","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Aarhus University Hospital , Aarhus 8200, Denmark"},{"name":"Department of Clinical Medicine, Faculty of Health, Aarhus University , Aarhus 8200 , Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan Carlos","family":"Kaski","sequence":"additional","affiliation":[{"name":"Molecular and Clinical Sciences Research Institute, St George's, University of London , London SW17 ORE , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Basil S","family":"Lewis","sequence":"additional","affiliation":[{"name":"Lady Davis Carmel Medical Center and Technion-Israel Institute of Technology , Haifa 3436212 , Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8888-0935","authenticated-orcid":false,"given":"Alexander","family":"Niessner","sequence":"additional","affiliation":[{"name":"Division of Cardiology, 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