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Review
. 2022 Oct 13;9(10):351.
doi: 10.3390/jcdd9100351.

Left Atrial Appendage Thrombosis and Oral Anticoagulants: A Meta-Analysis of Risk and Treatment Response

Yun-Yung Cheng  1 , Shennie Tan  1 , Chien-Tai Hong  1   2 , Cheng-Chang Yang  1   3 , Lung Chan  1   2
Affiliations
Review

Left Atrial Appendage Thrombosis and Oral Anticoagulants: A Meta-Analysis of Risk and Treatment Response

Yun-Yung Cheng et al. J Cardiovasc Dev Dis. .

Abstract

Background: Left atrial appendage thrombus (LAAT) is the main cause of cardioembolism in patients with nonvalvular atrial fibrillation (AF). Emerging evidence indicates that direct oral anticoagulants (DOACs) may be a preferred, safer choice for patients with LAAT. However, current guidelines indicate vitamin K antagonist (VKA) as the preferred treatment for LAAT. We conducted a meta-analysis to compare the efficacy of VKA and DOAC for the treatment of LAAT. Methods: The search was conducted in the PubMed, Embase, Google Scholar, and Cochrane Library databases from inception to July 2022, with the language restricted to English. A first analysis was conducted to evaluate the risk of LAAT under VKA or DOAC treatment. A second analysis was conducted to compare the resolution of LAAT under VKA and DOAC treatment. Results: In 13 studies comparing LAAT incidence rates under VKA and DOAC treatment, significant superiority of DOAC was detected (pooled RR = 0.65, 95% CI = 0.47-0.90, p = 0.009) with moderate heterogeneity being identified in the pooled studies. In 13 studies comparing LAAT resolution under VKA and DOAC use, treatment with DOAC exhibited a significantly increased probability of LAAT resolution compared with VKA (pooled odds ratio = 1.52, 95% CI = 1.02-2.26, p = 0.040). Conclusions: This meta-analysis suggests a superiority of DOAC over VKA with respect to LAAT incidence in people with AF and the likelihood of LAAT resolution. Due to their established safety profile, DOAC is a preferable choice for anticoagulation, although further randomized controlled studies are warranted to provide further evidence of their suitability as a new recommended treatment.

Keywords: atrial fibrillation; left atrial appendage thrombus; oral anticoagulant; stroke.

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Conflict of interest statement

The authors report no conflict of interest.

Figures

Figure 1
Figure 1
Flow diagram of study selection and search results.
Figure 2
Figure 2
(A) The forest plot of random-effect meta-analysis of the incidence of left arterial appendage thrombus formation under the use of vitamin K antagonist (VKA) and direct oral anticoagulants (DOACs). (B) The funnel plot of the studies included in the meta-analysis of the incidence of left arterial appendage thrombus formation under the use of vitamin K antagonist (VKA) and direct oral anticoagulants (DOACs).
Figure 2
Figure 2
(A) The forest plot of random-effect meta-analysis of the incidence of left arterial appendage thrombus formation under the use of vitamin K antagonist (VKA) and direct oral anticoagulants (DOACs). (B) The funnel plot of the studies included in the meta-analysis of the incidence of left arterial appendage thrombus formation under the use of vitamin K antagonist (VKA) and direct oral anticoagulants (DOACs).
Figure 3
Figure 3
(A) The forest plot of random-effect meta-analysis of the likelihood of resolution of left arterial appendage thrombus under the use of VKA and DOACs. (B) The funnel plot of the studies included in the meta-analysis of the likelihood of resolution of left arterial appendage thrombus under the use of VKA and DOACs.
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References

    1. Feigin V.L., Stark B.A., Johnson C.O., Roth G.A., Bisignano C., Abady G.G., Abbasifard M., Abbasi-Kangevari M., Abd-Allah F., Abedi V., et al. Global, regional, and national burden of stroke and its risk factors, 1990–2019: A systematic analysis for the Global Burden of Disease Study 2019. Lancet Neurol. 2021;20:795–820. doi: 10.1016/S1474-4422(21)00252-0. - DOI - PMC - PubMed
    1. Adams H.P., Bendixen B.H., Kappelle L.J., Biller J., Love B.B., Gordon D.L., Marsh E.E. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke. 1993;24:35–41. doi: 10.1161/01.STR.24.1.35. - DOI - PubMed
    1. Wolf P.A., Abbott R.D., Kannel W.B. Atrial fibrillation as an independent risk factor for stroke: The Framingham Study. Stroke. 1991;22:983–988. doi: 10.1161/01.STR.22.8.983. - DOI - PubMed
    1. Arboix A., Alio J. Cardioembolic stroke: Clinical features, specific cardiac disorders and prognosis. Curr. Cardiol. Rev. 2010;6:150–161. doi: 10.2174/157340310791658730. - DOI - PMC - PubMed
    1. Naksuk N., Padmanabhan D., Yogeswaran V., Asirvatham S.J. Left Atrial Appendage: Embryology, Anatomy, Physiology, Arrhythmia and Therapeutic Intervention. JACC Clin. Electrophysiol. 2016;2:403–412. doi: 10.1016/j.jacep.2016.06.006. - DOI - PubMed

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