Abstract 17888: Apixaban versus Vitamin K Antagonists for Left Ventricular Thrombus: A Systematic Review and Meta-Analysis

Introduction: Left ventricular thrombus (LVT), a major complication following acute myocardial infarction, significantly contributes to the increased risk of stroke and systemic embolism. Although vitamin K antagonists (VKAs) are the first-line treatment for LVT, direct oral anticoagulants (DOACs) have emerged as a potential alternative. However, the comparative effectiveness and safety of DOACs and VKAs for LVT treatment remain uncertain. Research question: Is apixaban therapy more effective and safer than VKA therapy for LVT? Aim: To assess the efficacy and safety of apixaban compared with VKAs therapy in patients with LVT. Methods: We systematically searched PubMed, Embase, and Cochrane databases for studies comparing the efficacy and safety of apixaban versus VKAs. We applied the random-effects model to calculate odds ratios (OR) and the corresponding 95% confidence interval. Heterogeneity was assessed using I 2 statistics. All calculations and graphics were performed using R (version 4.2.3). Results: Three randomized clinical trials (RCTs) were included, with 109 patients assigned to either apixaban (56 patients) or VKAs (53 patients). Compared to VKAs, apixaban showed no significant impact on thrombus resolution (OR 0.69; 95% CI 0.11-4.50; p=0.70; I 2 =0%), stroke reduction (OR 0.91; 95% CI 0.09-9.38; p=0.93; I 2 =1%), clinically relevant bleeding (OR 0.21; 95% CI 0.02-1.99; p=0.17; I 2 =0%), or all-cause mortality (OR 0.65; 95% CI 0.11-3.78; p=0.63; I 2 =8%). Conclusions: Apixaban therapy showed similar efficacy and safety to VKAs for LVT. These findings support the use of apixaban as an alternative to VKAs in LVT treatment.