{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T16:08:12Z","timestamp":1789834092746,"version":"4.0.1"},"reference-count":21,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2025,9,24]],"date-time":"2025-09-24T00:00:00Z","timestamp":1758672000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Left ventricular thrombus (LVT) remains a well-recognized complication following myocardial infarction (MI). Whilst vitamin K antagonists (VKAs) have traditionally been the cornerstone of management, direct oral anticoagulants (DOACs) have been increasingly utilized despite limited data to support this. We sought to perform an up-to-date meta-analysis of all randomized controlled trials (RCTs) comparing DOACs to VKAs for LVT resolution. Methods: A systematic search of major scientific databases was performed to identify RCTs published until May 2025. The primary efficacy endpoint was complete LVT resolution at 3 months. The risk ratio (RR) and 95% confidence intervals (CIs) of the individual RCTs were pooled via the inverse-variance method and random-effects model. Results: Seven RCTs involving 554 patients with a mean age of 54 years were included in the meta-analysis. At 3 months, there was no difference in the rate of LVT resolution between those in the DOAC arm and the warfarin arm (86% vs. 81%, RR 1.01 [95%CI 0.93\u20131.10], p = 0.76). There was low heterogeneity at I2 = 15%. There was no difference in major or clinically significant bleeding or in the composite of stroke or thromboembolic complications, although the 95%CIs were wide. Conclusions: DOACs appear to be comparable to warfarin in achieving LVT resolution at 3 months. These findings support the consideration of DOACs as alternatives to VKAs in selected patients for LVT resolution. Further adequately powered trials and head-to-head comparisons between DOACs are required to confirm their safety.<\/jats:p>","DOI":"10.3390\/jcm14196735","type":"journal-article","created":{"date-parts":[[2025,9,24]],"date-time":"2025-09-24T12:15:31Z","timestamp":1758716131000},"page":"6735","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["An Updated Meta-Analysis of Randomized Controlled Trials Comparing Direct Oral Anticoagulants Against Warfarin for Left Ventricular Thrombus Resolution"],"prefix":"10.3390","volume":"14","author":[{"given":"Joseph","family":"Magdy","sequence":"first","affiliation":[{"name":"Yorkshire Heart Centre, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds LS1 3EX, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2117-9607","authenticated-orcid":false,"given":"Maggie","family":"He","sequence":"additional","affiliation":[{"name":"Yorkshire Heart Centre, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds LS1 3EX, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sacchin","family":"Arockiam","sequence":"additional","affiliation":[{"name":"Yorkshire Heart Centre, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds LS1 3EX, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nanami","family":"Harada","sequence":"additional","affiliation":[{"name":"Yorkshire Heart Centre, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds LS1 3EX, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen B.","family":"Wheatcroft","sequence":"additional","affiliation":[{"name":"Yorkshire Heart Centre, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds LS1 3EX, UK"},{"name":"Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds LS1 3EX, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1985-1783","authenticated-orcid":false,"given":"Heerajnarain","family":"Bulluck","sequence":"additional","affiliation":[{"name":"Yorkshire Heart Centre, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds LS1 3EX, UK"},{"name":"Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds LS1 3EX, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e205","DOI":"10.1161\/CIR.0000000000001092","article-title":"Management of Patients at Risk for and With Left Ventricular Thrombus: A Scientific Statement From the American Heart Association","volume":"146","author":"Levine","year":"2022","journal-title":"Circulation"},{"key":"ref_2","first-page":"308","article-title":"Clinical Risk Score to Predict Early Left Ventricular Thrombus After ST-Segment Elevation Myocardial Infarction","volume":"14","author":"Holzknecht","year":"2021","journal-title":"Cardiovasc. 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