Efficacy and Safety Profile of Novel Oral Anticoagulants in the Treatment of Left Atrial Thrombosis: A Systematic Review and Meta-Analysis
ABSTRACT: Background: The presence of left atrial/left atrial appendage thrombosis is associated with a higher risk of thromboembolic events in patients with atrial fibrillation. The optimal antithrombotic strategy is not established to date. Objective: Our aim was to compare the efficacy and safet...
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| Format: | Article |
| Language: | English |
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Elsevier
2022-01-01
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| Series: | Current Therapeutic Research |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S0011393X22000091 |
| _version_ | 1828186060399575040 |
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| author | Shu-Jie Dong, MSc Cong-Yan Luo, MSc Cui-Lan Xiao, BSc Feng-Zhe Zhang, BSc Lei Li, MD Zhong-Ling Han, MSc Suo-Di Zhai, BSc |
| author_facet | Shu-Jie Dong, MSc Cong-Yan Luo, MSc Cui-Lan Xiao, BSc Feng-Zhe Zhang, BSc Lei Li, MD Zhong-Ling Han, MSc Suo-Di Zhai, BSc |
| author_sort | Shu-Jie Dong, MSc |
| collection | DOAJ |
| description | ABSTRACT: Background: The presence of left atrial/left atrial appendage thrombosis is associated with a higher risk of thromboembolic events in patients with atrial fibrillation. The optimal antithrombotic strategy is not established to date. Objective: Our aim was to compare the efficacy and safety profile of novel oral anticoagulants with warfarin in the treatment of left atrial/left atrial appendage thrombosis. Methods: We conducted a systematic search in PubMed, Embase, Cochrane Library, ClinicalTrials.gov, and 3 Chinese databases for all randomized controlled trials and cohort studies (PROSPERO, CRD42021238952) from inception to 7 May 2021. Two authors independently performed the articles selection, data extraction, and quality assessment. The efficacy outcome was the resolution of left atrial/left atrial appendage thrombosis, and the safety outcomes were bleeding and stroke/transient ischemic attack. Results: One randomized controlled trial and 5 cohort studies were included, with a total of 353 patients. Compared with warfarin, novel oral anticoagulants were associated with increased probability of left atrial/left atrial appendage thrombosis resolution (OR = 2.20; 95% CI, 1.35–3.60; I2 = 0%). Compared with warfarin, novel oral anticoagulants had a similar risk of bleeding (OR = 0.91; 95% CI, 0.39–2.13; I2 = 0%). There was no evidence of increased risk of stroke/transient ischemic attack (OR = 0.42; 95% CI, 0.12–1.45; I2 = 0%). Conclusions: Novel oral anticoagulants were more effective than warfarin in promoting the resolution of left atrial/left atrial appendage thrombosis, without increased risks of bleeding and stroke/transient ischemic attack. Our study provides valuable insight into clinical practice. Further well-designed randomized controlled trials are needed to fully evaluate the benefits and risks in these patients. PROSPERO Registration No.: CRD42021238952. |
| first_indexed | 2024-04-12T07:13:50Z |
| format | Article |
| id | doaj.art-61b94834eaec40a0b964528c5474f075 |
| institution | Directory Open Access Journal |
| issn | 0011-393X |
| language | English |
| last_indexed | 2024-04-12T07:13:50Z |
| publishDate | 2022-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Current Therapeutic Research |
| spelling | doaj.art-61b94834eaec40a0b964528c5474f0752022-12-22T03:42:33ZengElsevierCurrent Therapeutic Research0011-393X2022-01-0196100670Efficacy and Safety Profile of Novel Oral Anticoagulants in the Treatment of Left Atrial Thrombosis: A Systematic Review and Meta-AnalysisShu-Jie Dong, MSc0Cong-Yan Luo, MSc1Cui-Lan Xiao, BSc2Feng-Zhe Zhang, BSc3Lei Li, MD4Zhong-Ling Han, MSc5Suo-Di Zhai, BSc6Department of Pharmacy, Peking University Third Hospital, Beijing, ChinaDepartment of Pharmacy, Peking University Third Hospital, Beijing, China; Department of Pharmacy, Karamay Second People's Hospital, Karamay, ChinaDepartment of Pharmacy, Karamay Second People's Hospital, Karamay, ChinaSchool of Pharmaceutical Sciences, Peking University, Beijing, ChinaDepartment of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, Beijing, ChinaDepartment of Pharmacy, Beijing Road Medical Area of Xinjiang Military Region General Hospital, Urumqi, ChinaDepartment of Pharmacy, Peking University Third Hospital, Beijing, China; Address correspondence to: Suo-Di Zhai, BSc, Department of Pharmacy, Peking University Third Hospital, No. 49 N Garden Rd, Haidian District, Beijing, China.ABSTRACT: Background: The presence of left atrial/left atrial appendage thrombosis is associated with a higher risk of thromboembolic events in patients with atrial fibrillation. The optimal antithrombotic strategy is not established to date. Objective: Our aim was to compare the efficacy and safety profile of novel oral anticoagulants with warfarin in the treatment of left atrial/left atrial appendage thrombosis. Methods: We conducted a systematic search in PubMed, Embase, Cochrane Library, ClinicalTrials.gov, and 3 Chinese databases for all randomized controlled trials and cohort studies (PROSPERO, CRD42021238952) from inception to 7 May 2021. Two authors independently performed the articles selection, data extraction, and quality assessment. The efficacy outcome was the resolution of left atrial/left atrial appendage thrombosis, and the safety outcomes were bleeding and stroke/transient ischemic attack. Results: One randomized controlled trial and 5 cohort studies were included, with a total of 353 patients. Compared with warfarin, novel oral anticoagulants were associated with increased probability of left atrial/left atrial appendage thrombosis resolution (OR = 2.20; 95% CI, 1.35–3.60; I2 = 0%). Compared with warfarin, novel oral anticoagulants had a similar risk of bleeding (OR = 0.91; 95% CI, 0.39–2.13; I2 = 0%). There was no evidence of increased risk of stroke/transient ischemic attack (OR = 0.42; 95% CI, 0.12–1.45; I2 = 0%). Conclusions: Novel oral anticoagulants were more effective than warfarin in promoting the resolution of left atrial/left atrial appendage thrombosis, without increased risks of bleeding and stroke/transient ischemic attack. Our study provides valuable insight into clinical practice. Further well-designed randomized controlled trials are needed to fully evaluate the benefits and risks in these patients. PROSPERO Registration No.: CRD42021238952.http://www.sciencedirect.com/science/article/pii/S0011393X22000091left atrialmeta-analysisoral anticoagulantssystematic reviewthrombosiswarfarin |
| spellingShingle | Shu-Jie Dong, MSc Cong-Yan Luo, MSc Cui-Lan Xiao, BSc Feng-Zhe Zhang, BSc Lei Li, MD Zhong-Ling Han, MSc Suo-Di Zhai, BSc Efficacy and Safety Profile of Novel Oral Anticoagulants in the Treatment of Left Atrial Thrombosis: A Systematic Review and Meta-Analysis Current Therapeutic Research left atrial meta-analysis oral anticoagulants systematic review thrombosis warfarin |
| title | Efficacy and Safety Profile of Novel Oral Anticoagulants in the Treatment of Left Atrial Thrombosis: A Systematic Review and Meta-Analysis |
| title_full | Efficacy and Safety Profile of Novel Oral Anticoagulants in the Treatment of Left Atrial Thrombosis: A Systematic Review and Meta-Analysis |
| title_fullStr | Efficacy and Safety Profile of Novel Oral Anticoagulants in the Treatment of Left Atrial Thrombosis: A Systematic Review and Meta-Analysis |
| title_full_unstemmed | Efficacy and Safety Profile of Novel Oral Anticoagulants in the Treatment of Left Atrial Thrombosis: A Systematic Review and Meta-Analysis |
| title_short | Efficacy and Safety Profile of Novel Oral Anticoagulants in the Treatment of Left Atrial Thrombosis: A Systematic Review and Meta-Analysis |
| title_sort | efficacy and safety profile of novel oral anticoagulants in the treatment of left atrial thrombosis a systematic review and meta analysis |
| topic | left atrial meta-analysis oral anticoagulants systematic review thrombosis warfarin |
| url | http://www.sciencedirect.com/science/article/pii/S0011393X22000091 |
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