Abstract
BackgroundHigh risk of embolic events exists in both patients with chronic atrial fibrillation (AF) and patients in the perioperative period of ablation (effective treatment for AF). Therefore, anticoagulant therapy is important. Oral anticoagulants can be divided into two major categories: vitamin K antagonists (VKAs) and non-vitamin K antagonist oral anticoagulants (NOACs). VKAs, represented by warfarin, have been widely used as traditional anticoagulants, whereas NOACs have been used in clinical practice, but their anticoagulant effects and side effects are still the focus of research. We used a meta-analysis to compare the incidence of left atrial thrombi (LAT) between different anticoagulants.MethodsWe searched PubMed, EMBASE, Web of Science, and the Cochrane Library databases for observational studies that compared the transesophageal echocardiography (TEE) findings for patients treated with NOACs and VKAs. The incidence of LAT and dense spontaneous echocardiographic contrast (dense SEC) were extracted as the basis of the meta-analysis.ResultsFifteen studies were included in the meta-analysis. We found that patients anticoagulated with NOACs and VKAs had similar incidence of LAT (OR = 0.74, 95%CI: 0.55–1.00). After excluding the heterogeneous article by sensitivity analysis, we found the incidence of LAT in patients anticoagulated with NOACs is lower than VKAs (OR = 0.59, 95%CI: 0.42–0.84). The results of subgroup analysis showed that the incidence of LAT among three types of NOACs have no significant difference (dabigatran vs. rivaroxaban, OR = 1.16 [0.75, 1.81]; rivaroxaban vs. apixaban, OR = 0.97 [0.54, 1.74]; dabigatran vs. apixaban, OR = 1.09 [0.55, 2.16]).ConclusionPatients anticoagulated with NOACs may have lower incidence of LAT than VKAs. The incidence of LAT among different type of NOACs are similar.
Highlights
High risk of embolic events exists in both patients with chronic atrial fibrillation (AF) and patients in the perioperative period of ablation
In this study, we compared the incidence of left atrial thrombi (LAT) in patients with AF anticoagulated with non-vitamin K antagonist oral anticoagulants (NOACs) or vitamin K antagonists (VKAs), and we detected no significant difference between NOACs and VKAs (OR: 0.74, 95% confidence interval (CI): 0.55–1.00)
To further analyze the heterogeneity between the studies included, we performed a sensitivity analysis and found that four studies significantly influenced the pooled effects, indicating that they differed significantly from the other studies. When we omitted these studies from the metaanalysis, the incidence of LAT in patients anticoagulated with NOACs is lower than VKAs (OR: 0.59, 95% CI: 0.42– 0.84)
Summary
High risk of embolic events exists in both patients with chronic atrial fibrillation (AF) and patients in the perioperative period of ablation (effective treatment for AF). We used a meta-analysis to compare the incidence of left atrial thrombi (LAT) between different anticoagulants. Research has previously shown that left atrial thrombi (LAT) are the main source of embolism and stroke [6]. The formation of LAT must be prevented in patients with AF with either drug-induced anticoagulation or occlusion of the left atrial appendage [7]. Anticoagulant drugs can be divided into two categories: vitamin K antagonists (VKAs) and non-vitamin K antagonist oral anticoagulants (NOACs). VKAs, the anticoagulants first used in AF patients, can significantly reduce the risk of stroke and death [8]. Research on the anticoagulant effects and side effects of NOACs is still topical
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