Evidence map›Paper›PMID 39297938›Full record

ArticleClinical research in cardiology : official journal of the German Cardiac Society2024

Oral anticoagulation in patients with left ventricular thrombus: a systematic review and network meta-analysis with reconstructed time-to-event data.

Sebastian Heyne, Sascha Macherey-Meyer, Max M Meertens, Karl Finke, Stephan Baldus, Christoph Adler, Samuel Lee

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Article in Clinical research in cardiology : official journal of the German Cardiac Society, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed.

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4 · The record

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PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Sebastian HeyneFaculty of Medicine, University of Cologne, University Hospital Cologne, Clinic III for Internal Medicine, Kerpener Str. 62, 50937, Cologne, Germany. sebastian.heyne@uk-koeln.de.ORCID http://orcid.org/0000-0002-1581-9954
Sascha Macherey-MeyerFaculty of Medicine, University of Cologne, University Hospital Cologne, Clinic III for Internal Medicine, Kerpener Str. 62, 50937, Cologne, Germany.
Max M MeertensCenter of Cardiology, Cardiology III - Angiology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany.
Karl FinkeFaculty of Medicine, University of Cologne, University Hospital Cologne, Clinic III for Internal Medicine, Kerpener Str. 62, 50937, Cologne, Germany.
Stephan BaldusFaculty of Medicine, University of Cologne, University Hospital Cologne, Clinic III for Internal Medicine, Kerpener Str. 62, 50937, Cologne, Germany.
Christoph AdlerDepartment of Emergency Medicine, Leverkusen Medical Center, Leverkusen, Germany.
Samuel LeeFaculty of Medicine, University of Cologne, University Hospital Cologne, Clinic III for Internal Medicine, Kerpener Str. 62, 50937, Cologne, Germany.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundLeft ventricular thrombus (LVT) is associated with high rates of systemic embolism. Vitamin K antagonists (VKAs) are the only approved treatment for LVT. Although evidence suggests direct oral anticoagulant (DOACs) to be at least equally effective in general, the efficacy of individual DOACs remains unclear.

methodsA literature search was performed in EMBASE, MEDLINE and Web of Science looking for randomized controlled trials (RCTs) and non-randomized controlled studies of interventions (NRSI) comparing individual DOACs to VKAs for the treatment of LVT. Individual patient data was reconstructed and incorporated in a Bayesian network meta-analysis (NMA) and a Cox frailty regression model.

resultsA total of 2545 patients across 19 studies (4 RCTs, 15 NRSI) were included. 1738 received VKAs, 581 received Rivaroxaban, 226 received Apixaban, 82 received Dabigatran and 2 received Edoxaban. LVT resolution was less likely with VKAs compared to Rivaroxaban in the time-to-event analysis (HR 0.66, 95% CI [0.49; 0.91], p = 0.01). There was no difference for other DOACs compared to VKAs. Rivaroxaban reduced ischemic stroke compared to VKAs (OR 0.18, 95% CrI [0.05; 0.49]), other DOACs did not.

conclusionIn this NMA, Rivaroxaban showed faster LVT resolution and consecutively lower odds of ischemic stroke than VKAs while Apixaban and Dabigatran showed at least equal efficacy. Given the quality and size of the available studies, these differences between individual DOACs should be acknowledged as hypothesis generating only. Future adequately powered randomized controlled trials are needed to assess possible time-varying effects between individual DOACs.

Indexed as

DOACLV thrombusVKA

Identifiers

PMID39297938

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.