{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,8]],"date-time":"2026-11-08T10:33:56Z","timestamp":1794134036624,"version":"4.8.0"},"reference-count":25,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2025,11,19]],"date-time":"2025-11-19T00:00:00Z","timestamp":1763510400000},"content-version":"unspecified","delay-in-days":141,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100006538","name":"School of Medicine, Vanderbilt University","doi-asserted-by":"publisher","award":["BMJ Group\u2019s OA agreement, Ringgold ID: 5718"],"award-info":[{"award-number":["BMJ Group\u2019s OA agreement, Ringgold ID: 5718"]}],"id":[{"id":"10.13039\/100006538","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Open Heart"],"accepted":{"date-parts":[[2025,11,8]]},"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Left ventricular (LV) thrombus is a complication of myocardial infarction and dilated cardiomyopathy and is associated with a high thromboembolic risk. Although warfarin has traditionally been used, direct oral anticoagulants (DOACs) offer a more convenient alternative. With the addition of the RIVAWAR trial, we conducted an updated systematic review and meta-analysis to assess the efficacy and safety of DOACs compared with warfarin in patients with LV thrombus.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A systematic search of electronic databases (PubMed, EMBASE, Cochrane and clinicaltrials.gov) from inception to April 2025 identified randomised clinical trials (RCTs) comparing DOACs with warfarin for the treatment of LV thrombus. The main outcome of interest was thrombus resolution at 3 months. Risk ratios (RRs) with 95% CIs were calculated using random-effects models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Seven RCTs comprising 554 patients were included. Non-contrast transthoracic echocardiography was used for LV thrombus assessment in all RCTs. There was no difference between DOACs and warfarin in thrombus resolution at 3 months (RR 1.02; 95%\u2009CI 0.95 to 1.09), major adverse cardiovascular events (RR 0.50; 95%\u2009CI 0.16 to 1.54), all-cause mortality (RR 0.92; 95%\u2009CI 0.36 to 2.31), stroke\/systemic embolism (RR 0.76; 95%\u2009CI 0.12 to 4.68), rehospitalisation (RR 1.36; 95%\u2009CI 0.47 to 3.94) or major bleeding (RR 0.54; 95%\u2009CI 0.20 to 1.48). Subgroup and sensitivity analyses confirmed the robustness of these results.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>DOACs demonstrated similar efficacy and safety to warfarin for LV thrombus management in this meta-analysis, supporting their use for the treatment of LV thrombus. However, large-scale RCTs with longer follow-up periods and using diagnostic modalities with higher sensitivity and specificity for detecting LV thrombus resolution are warranted to confirm these findings and clarify long-term outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>PROSPERO registration number<\/jats:title>\n                    <jats:p>CRD420251023513.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/openhrt-2025-003542","type":"journal-article","created":{"date-parts":[[2025,11,20]],"date-time":"2025-11-20T08:51:09Z","timestamp":1763628669000},"page":"e003542","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Efficacy and safety of direct oral anticoagulants versus warfarin in patients with a left ventricular thrombus: an updated systematic review and meta-analysis of randomised controlled trials"],"prefix":"10.1136","volume":"12","clinical-trial-number":[{"clinical-trial-number":"nct06013020","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct05892042","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct05705089","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1789-6694","authenticated-orcid":false,"given":"Thomaz Alexandre","family":"Costa","sequence":"first","affiliation":[{"name":"Department of Medicine, University of Colorado Anschutz Medical Campus School of Medicine, Aurora, Colorado, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7398-9070","authenticated-orcid":false,"given":"Gabriel Cavalcante Lima","family":"Chagas","sequence":"additional","affiliation":[{"name":"Department of Medicine, Cleveland Clinic, Cleveland, Ohio, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-9019-0130","authenticated-orcid":false,"given":"Luma Maria","family":"Tavares de Sousa","sequence":"additional","affiliation":[{"name":"Department of Medicine, Universidade Federal do Ceara Faculdade de Medicina, Fortaleza, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-3188-6900","authenticated-orcid":false,"given":"Bruno","family":"Lins de Souza","sequence":"additional","affiliation":[{"name":"Department of Medicine, Universidade Federal do Ceara Faculdade de Medicina, Fortaleza, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole","family":"Felix","sequence":"additional","affiliation":[{"name":"Department of Medicine, Federal University of Campina Grande, Campina Grande, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Josephine","family":"Harrington","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Colorado Anschutz Medical Campus School of Medicine, Aurora, Colorado, USA"},{"name":"Colorado Prevention Center, Aurora, Colorado, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruno Bezerra","family":"Lima","sequence":"additional","affiliation":[{"name":"Department of Medicine, Cardiology Division, Vanderbilt University Medical Center, Nashville, Tennessee, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,11,19]]},"reference":[{"key":"2025112000502600000_12.2.e003542.1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2020.01.057"},{"key":"2025112000502600000_12.2.e003542.2","doi-asserted-by":"crossref","first-page":"2032","DOI":"10.1002\/ehf2.12718","article-title":"Direct oral anticoagulants compared to vitamin K antagonist for the management of left ventricular thrombus","volume":"7","author":"Iqbal","year":"2020","journal-title":"ESC Heart Fail"},{"key":"2025112000502600000_12.2.e003542.3","doi-asserted-by":"crossref","first-page":"82","DOI":"10.4244\/EIJ-D-24-00527","article-title":"Direct oral anticoagulants or warfarin in patients with left ventricular thrombus after ST-elevation myocardial infarction: a pilot trial and a prespecified meta-analysis of randomised trials","volume":"21","author":"Jenab","year":"2025","journal-title":"EuroIntervention"},{"key":"2025112000502600000_12.2.e003542.4","doi-asserted-by":"crossref","DOI":"10.1186\/s12968-018-0494-3","article-title":"Incidence and predictors of left ventricular thrombus by cardiovascular magnetic resonance in acute ST-segment elevation myocardial infarction treated by primary percutaneous coronary intervention: a meta-analysis","volume":"20","author":"Bulluck","year":"2018","journal-title":"J Cardiovasc Magn Reson"},{"key":"2025112000502600000_12.2.e003542.5","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1093\/eurheartj\/ehx551","article-title":"Anticoagulation combined with antiplatelet therapy in patients with left ventricular thrombus after first acute myocardial infarction","volume":"39","author":"Maniwa","year":"2018","journal-title":"Eur Heart J"},{"key":"2025112000502600000_12.2.e003542.6","doi-asserted-by":"crossref","unstructured":"Wang X , Ma Y , Hui X , et al . Oral direct thrombin inhibitors or oral factor Xa inhibitors versus conventional anticoagulants for the treatment of deep vein thrombosis. Cochrane Database Syst Rev 2023;2023. doi:10.1002\/14651858.CD010956.pub3","DOI":"10.1002\/14651858.CD010956.pub3"},{"key":"2025112000502600000_12.2.e003542.7","doi-asserted-by":"crossref","unstructured":"Levine GN , McEvoy JW , Fang JC , et al . Management of Patients at Risk for and With Left Ventricular Thrombus: A Scientific Statement From the American Heart Association. 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Cochrane handbook for systematic reviews of interventions version 6.3. Cochrane, 2022."},{"key":"2025112000502600000_12.2.e003542.15","doi-asserted-by":"crossref","unstructured":"Mourao E , Kalinowski M , Murta L , et al . Investigating the use of a hybrid search strategy for systematic reviews. 2017 ACM\/IEEE International Symposium on Empirical Software Engineering and Measurement (ESEM); 2017:193\u20138. Available: https:\/\/doi.org\/10.1109\/ESEM.2017.30","DOI":"10.1109\/ESEM.2017.30"},{"key":"2025112000502600000_12.2.e003542.16","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.l4898","article-title":"RoB 2: a revised tool for assessing risk of bias in randomised trials","volume":"366","author":"Sterne","year":"2019","journal-title":"BMJ"},{"key":"2025112000502600000_12.2.e003542.17","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.327.7414.557"},{"key":"2025112000502600000_12.2.e003542.18","unstructured":"Deeks JJ , Higgins J . Chapter 10: analysing data and undertaking meta-analyses. In: Higgins JPT , Thomas J , Chandler J , et al ., eds. Cochrane handbook for systematic reviews of interventions version 6.3. 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