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New Insights into Antithrombotic Therapy for Cardio- and Cerebrovascular Disease:...
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New Insights into Antithrombotic Therapy for Cardio- and Cerebrovascular Disease: From Molecular Mechanisms to Clinical Application

A special issue of Journal of Cardiovascular Development and Disease (ISSN 2308-3425). This special issue belongs to the section "Stroke and Cerebrovascular Disease".

Deadline for manuscript submissions: closed (28 February 2023) | Viewed by 31211

Printed Edition Available!
A printed edition of this Special Issue is available here.

Special Issue Editors

Prof. Dr. Giovanni Cimmino

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Guest Editor
1. Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli, 80131 Naples, Italy
2. Vanvitelli Cardiology Unit, Monaldi Hospital, 80131 Naples, Italy
Interests: coagulation cascade; tissue factor; platelet pathophysiology; acute coronary syndrome; atherosclerosis; lipoprotein metabolism
Special Issues, Collections and Topics in MDPI journals
Prof. Dr. Plinio Cirillo

E-Mail Website
Guest Editor
Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
Interests: interventional cardiology; transcatheter aortic valve implantation; percutaneous coronary intervention; coronary artery; aortic stenosis
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Atherosclerotic disease and its thrombotic complication are the pathophysiological substrate underlying several clinical conditions, such as acute and chronic coronary syndrome (ACS and CCS, respectively), stroke, and peripheral artery disease. Activation of coagulation cascade as well as platelet aggregation are key steps of the thrombotic process. Vessel injury results in exposure of the glycoprotein tissue factor (TF) to flowing blood. Once exposed, TF binds factor VII/VIIa (FVII/FVIIa), and in the presence of calcium ions, it forms a tertiary complex able to activate FX to FXa, FIX to FIXa, and FVIIa itself. The final step is thrombin formation at the site of vessel injury with subsequent platelet activation, fibrinogen to fibrin conversion, and ultimately thrombus formation. Platelets are crucial cells in primary hemostasis. For years, they have been considered only as cell fragments participating in primary hemostasis. However, recent advances in platelets pathophysiology have shown that these cells are able to regulate their gene and protein expression, make de novo protein synthesis, and release different mediators with paracrine effects that may interfere with different cell function. Pharmacological modulation of both components of thrombosis, the coagulation cascade and platelet activation, is of great clinical importance. Several clinical trials have clearly shown the efficacy of anticoagulation and/or anti platelet aggregation in different thrombotic disorders. However, real-world practice clearly indicated that antithrombotic strategies need to be personalized according to patient characteristics, such as age, concomitant diseases already requiring antithrombotic drugs or at risk for bleeding. In this regard, the combination of multiple antithrombotic drugs represents a challenging scenario and was therefore the focus for multiple recent randomized controlled trials, with more still to come. As knowledge about platelets and the coagulation system has substantially evolved within the last few years, so should our approach to antithrombotic treatment. Finally, the ongoing global pandemic of coronavirus disease 2019 (COVID‑19) has also modified our antithrombotic strategies for acute ischemic events.

This issue will focus on current hurdles of antithrombotic treatments in patients with cardio- and cerebrovascular diseases, starting from the molecular mechanisms involved, proposing practical solutions to compelling clinical scenarios using a pathophysiology-oriented approach on the basis of current clinical evidence.

Prof. Dr. Giovanni Cimmino
Prof. Dr. Plinio Cirillo
Guest Editors

Manuscript Submission Information

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Cardiovascular Development and Disease is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2700 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • tissue factor
  • coagulation cascade
  • platelets
  • aggregation
  • thrombosis
  • acute coronary syndrome
  • stroke
  • peripheral artery disease
  • COVID-19 pandemic

Published Papers (11 papers)

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Editorial

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4 pages, 205 KiB  
Editorial
New Insights into Antithrombotic Therapy for Cardio- and Cerebrovascular Disease: From Molecular Mechanisms to Clinical Application
by Plinio Cirillo and Giovanni Cimmino
J. Cardiovasc. Dev. Dis. 2023, 10(6), 258; https://doi.org/10.3390/jcdd10060258 - 14 Jun 2023
Viewed by 920
Abstract
Thrombosis has a pivotal role in the pathophysiology of acute cardiovascular events such as myocardial infarction and stroke [...] Full article
(This article belongs to the Special Issue New Insights into Antithrombotic Therapy for Cardio- and Cerebrovascular Disease: From Molecular Mechanisms to Clinical Application)

Research

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14 pages, 5987 KiB  
Article
Metformin Directly Binds to MMP-9 to Improve Plaque Stability
by Xianda Chen, Shuaixing Wang, Wenli Xu, Mingming Zhao, Youyi Zhang and Han Xiao
J. Cardiovasc. Dev. Dis. 2023, 10(2), 54; https://doi.org/10.3390/jcdd10020054 - 30 Jan 2023
Cited by 2 | Viewed by 2083
Abstract
Vulnerable atherosclerotic plaque rupture is the principal mechanism that accounts for myocardial infarction and stroke. High matrix metalloproteinase-9 (MMP-9) expression and activity have been proven to lead to plaque instability. Metformin, a first-line treatment for type 2 diabetes, is beneficial to plaque vulnerability. [...] Read more.
Vulnerable atherosclerotic plaque rupture is the principal mechanism that accounts for myocardial infarction and stroke. High matrix metalloproteinase-9 (MMP-9) expression and activity have been proven to lead to plaque instability. Metformin, a first-line treatment for type 2 diabetes, is beneficial to plaque vulnerability. However, the mechanism underlying its anti-atherogenic effect remains unclear. Molecular docking and surface plasmon resonance experiments showed that metformin directly interacts with MMP-9, and incubated MMP-9 overexpressing HEK293A cells with metformin (1 μmol·L−1) significantly attenuates MMP-9’s activity using zymography and MMP activity assays. Moreover, metformin treatment drives MMP-9 degradation. Next, we constructed a carotid artery atherosclerotic plaque model and administered consecutive 14-day metformin (200 mg·kg−1·d−1) treatment by intragastric gavage. Immunofluorescence staining of the right carotid common artery and serum MMP activity assay results showed that metformin treatment decreased local plaque MMP-9 protein level and circulating MMP-9 activity, respectively. Histochemical staining revealed that after metformin treatment, the collagen content in plaque was significantly preserved, and the plaque vulnerability index decreased. These findings suggested that metformin improved atherosclerotic plaque stability by directly binding to MMP-9 and driving its degradation. Full article
(This article belongs to the Special Issue New Insights into Antithrombotic Therapy for Cardio- and Cerebrovascular Disease: From Molecular Mechanisms to Clinical Application)
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Review

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23 pages, 1702 KiB  
Review
Antithrombotic Therapy in Peripheral Artery Disease: Current Evidence and Future Directions
by Mario Enrico Canonico, Raffaele Piccolo, Marisa Avvedimento, Attilio Leone, Salvatore Esposito, Anna Franzone, Giuseppe Giugliano, Giuseppe Gargiulo, Connie N. Hess, Scott D. Berkowitz, Judith Hsia, Plinio Cirillo, Giovanni Esposito and Marc P. Bonaca
J. Cardiovasc. Dev. Dis. 2023, 10(4), 164; https://doi.org/10.3390/jcdd10040164 - 10 Apr 2023
Cited by 7 | Viewed by 3435
Abstract
Patients with peripheral artery disease (PAD) are at an increased risk of major adverse cardiovascular events, and those with disease in the lower extremities are at risk of major adverse limb events primarily driven by atherothrombosis. Traditionally, PAD refers to diseases of the [...] Read more.
Patients with peripheral artery disease (PAD) are at an increased risk of major adverse cardiovascular events, and those with disease in the lower extremities are at risk of major adverse limb events primarily driven by atherothrombosis. Traditionally, PAD refers to diseases of the arteries outside of the coronary circulation, including carotid, visceral and lower extremity peripheral artery disease, and the heterogeneity of PAD patients is represented by different atherothrombotic pathophysiology, clinical features and related antithrombotic strategies. The risk in this diverse population includes systemic risk of cardiovascular events as well as risk related to the diseased territory (e.g., artery to artery embolic stroke for patients with carotid disease, lower extremity artery to artery embolism and atherothrombosis in patients with lower extremity disease). Moreover, until the last decade, clinical data on antithrombotic management of PAD patients have been drawn from subanalyses of randomized clinical trials addressing patients affected by coronary artery disease. The high prevalence and related poor prognosis in PAD patients highlight the pivotal role of tailored antithrombotic therapy in patients affected by cerebrovascular, aortic and lower extremity peripheral artery disease. Thus, the proper assessment of thrombotic and hemorrhagic risk in patients with PAD represents a key clinical challenge that must be met to permit the optimal antithrombotic prescription for the various clinical settings in daily practice. The aim of this updated review is to analyze different features of atherothrombotic disease as well as current evidence of antithrombotic management in asymptomatic and secondary prevention in PAD patients according to each arterial bed. Full article
(This article belongs to the Special Issue New Insights into Antithrombotic Therapy for Cardio- and Cerebrovascular Disease: From Molecular Mechanisms to Clinical Application)
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16 pages, 796 KiB  
Review
Dual Antiplatelet Therapy with Parenteral P2Y12 Inhibitors: Rationale, Evidence, and Future Directions
by Giulia Alagna, Paolo Mazzone, Marco Contarini and Giuseppe Andò
J. Cardiovasc. Dev. Dis. 2023, 10(4), 163; https://doi.org/10.3390/jcdd10040163 - 09 Apr 2023
Cited by 3 | Viewed by 3663
Abstract
Dual antiplatelet therapy (DAPT), consisting of the combination of aspirin and an inhibitor of the platelet P2Y12 receptor for ADP, remains among the most investigated treatments in cardiovascular medicine. While a substantial amount of research initially stemmed from the observations of late [...] Read more.
Dual antiplatelet therapy (DAPT), consisting of the combination of aspirin and an inhibitor of the platelet P2Y12 receptor for ADP, remains among the most investigated treatments in cardiovascular medicine. While a substantial amount of research initially stemmed from the observations of late and very late stent thrombosis events in the first-generation drug-eluting stent (DES) era, DAPT has been recently transitioning from a purely stent-related to a more systemic secondary prevention strategy. Oral and parenteral platelet P2Y12 inhibitors are currently available for clinical use. The latter have been shown to be extremely suitable in drug-naïve patients with acute coronary syndrome (ACS), mainly because oral P2Y12 inhibitors are associated with delayed efficacy in patients with STEMI and because pre-treatment with P2Y12 inhibitors is discouraged in NSTE-ACS, and in patients with recent DES implantation and in need of urgent cardiac and non-cardiac surgery. More definitive evidence is needed, however, about optimal switching strategies between parenteral and oral P2Y12 inhibitors and about newer potent subcutaneous agents that are being developed for the pre-hospital setting. Full article
(This article belongs to the Special Issue New Insights into Antithrombotic Therapy for Cardio- and Cerebrovascular Disease: From Molecular Mechanisms to Clinical Application)
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11 pages, 588 KiB  
Review
Pharmacological Efficacy and Gastrointestinal Safety of Different Aspirin Formulations for Cardiovascular Prevention: A Narrative Review
by Bianca Clerici and Marco Cattaneo
J. Cardiovasc. Dev. Dis. 2023, 10(4), 137; https://doi.org/10.3390/jcdd10040137 - 23 Mar 2023
Cited by 3 | Viewed by 2304
Abstract
Aspirin inhibits platelet function by irreversibly inhibiting the synthesis of thromboxane A2 (TxA2). Aspirin, at low doses, is widely used for cardiovascular prevention. Gastrointestinal discomfort, mucosal erosions/ulcerations and bleeding are frequent complications of chronic treatment. To reduce these adverse effects, different formulations of [...] Read more.
Aspirin inhibits platelet function by irreversibly inhibiting the synthesis of thromboxane A2 (TxA2). Aspirin, at low doses, is widely used for cardiovascular prevention. Gastrointestinal discomfort, mucosal erosions/ulcerations and bleeding are frequent complications of chronic treatment. To reduce these adverse effects, different formulations of aspirin have been developed, including enteric-coated (EC) aspirin, the most widely used aspirin formulation. However, EC aspirin is less effective than plain aspirin in inhibiting TxA2 production, especially in subjects with high body weight. The inadequate pharmacological efficacy of EC aspirin is mirrored by lower protection from cardiovascular events in subjects weighing >70 kg. Endoscopic studies showed that EC aspirin causes fewer erosions of the gastric mucosa compared to plain aspirin (which is absorbed in the stomach) but causes mucosal erosions in the small intestine, where it is absorbed. Several studies demonstrated that EC aspirin does not reduce the incidence of clinically relevant gastrointestinal ulceration and bleeding. Similar results were found for buffered aspirin. Although interesting, the results of experiments on the phospholipid-aspirin complex PL2200 are still preliminary. Considering its favorable pharmacological profile, plain aspirin should be the preferred formulation to be used for cardiovascular prevention. Full article
(This article belongs to the Special Issue New Insights into Antithrombotic Therapy for Cardio- and Cerebrovascular Disease: From Molecular Mechanisms to Clinical Application)
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16 pages, 967 KiB  
Review
Dual Antiplatelet Therapy and Cancer; Balancing between Ischemic and Bleeding Risk: A Narrative Review
by Grigorios Tsigkas, Angeliki Vakka, Anastasios Apostolos, Eleni Bousoula, Nikolaos Vythoulkas-Biotis, Eleni-Evangelia Koufou, Georgios Vasilagkos, Ioannis Tsiafoutis, Michalis Hamilos, Adel Aminian and Periklis Davlouros
J. Cardiovasc. Dev. Dis. 2023, 10(4), 135; https://doi.org/10.3390/jcdd10040135 - 23 Mar 2023
Cited by 3 | Viewed by 2124
Abstract
Cardiovascular (CV) events in patients with cancer can be caused by concomitant CV risk factors, cancer itself, and anticancer therapy. Since malignancy can dysregulate the hemostatic system, predisposing cancer patients to both thrombosis and hemorrhage, the administration of dual antiplatelet therapy (DAPT) to [...] Read more.
Cardiovascular (CV) events in patients with cancer can be caused by concomitant CV risk factors, cancer itself, and anticancer therapy. Since malignancy can dysregulate the hemostatic system, predisposing cancer patients to both thrombosis and hemorrhage, the administration of dual antiplatelet therapy (DAPT) to patients with cancer who suffer from acute coronary syndrome (ACS) or undergo percutaneous coronary intervention (PCI) is a clinical challenge to cardiologists. Apart from PCI and ACS, other structural interventions, such as TAVR, PFO-ASD closure, and LAA occlusion, and non-cardiac diseases, such as PAD and CVAs, may require DAPT. The aim of the present review is to review the current literature on the optimal antiplatelet therapy and duration of DAPT for oncologic patients, in order to reduce both the ischemic and bleeding risk in this high-risk population. Full article
(This article belongs to the Special Issue New Insights into Antithrombotic Therapy for Cardio- and Cerebrovascular Disease: From Molecular Mechanisms to Clinical Application)
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17 pages, 1775 KiB  
Review
Anticoagulation for Left Ventricle Thrombus—Case Series and Literature Review for Use of Direct Oral Anticoagulants
by Akshyaya Pradhan, Monika Bhandari, Pravesh Vishwakarma, Chiara Salimei, Ferdinando Iellamo, Rishi Sethi and Marco Alfonso Perrone
J. Cardiovasc. Dev. Dis. 2023, 10(2), 41; https://doi.org/10.3390/jcdd10020041 - 23 Jan 2023
Cited by 1 | Viewed by 2206
Abstract
Left ventricular thrombus is a known complication following acute myocardial infarction that can lead to systemic thromboembolism. To obviate the risk of thromboembolism, the patient needs anticoagulation in addition to dual antiplatelet therapy. However, combining antiplatelets with anticoagulants substantially increases the bleeding risk. [...] Read more.
Left ventricular thrombus is a known complication following acute myocardial infarction that can lead to systemic thromboembolism. To obviate the risk of thromboembolism, the patient needs anticoagulation in addition to dual antiplatelet therapy. However, combining antiplatelets with anticoagulants substantially increases the bleeding risk. Traditionally, vitamin K antagonists (VKAs) have been the sheet anchor for anticoagulation in this scenario. The use of direct oral anticoagulants has significantly attenuated the bleeding risk associated with anticoagulation for atrial fibrillation and venous thromboembolism. Furthermore, in patients with atrial fibrillation undergoing percutaneous coronary intervention, the use of direct oral anticoagulants (DOACs) in conjunction with antiplatelets has been found to be noninferior in reducing ischemic events while significantly attenuating the bleeding compared with VKA. After initial case reports, multiple observational and nonrandomized studies have now safely and effectively utilized direct oral anticoagulants for anticoagulation in left ventricular thrombus. Here, we report a series of two cases presenting with left ventricular thrombus following acute myocardial infarction. In this case series, we try to address the issues concerning the choice and duration of anticoagulation in the case of postinfarct left ventricular thrombus. Pending the results of large randomized control trials, the judicious use of direct oral anticoagulant is warranted when taking into consideration the ischemic and bleeding profile in an individualized approach. Full article
(This article belongs to the Special Issue New Insights into Antithrombotic Therapy for Cardio- and Cerebrovascular Disease: From Molecular Mechanisms to Clinical Application)
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17 pages, 1131 KiB  
Review
Factor XI/XIa Inhibition: The Arsenal in Development for a New Therapeutic Target in Cardio- and Cerebrovascular Disease
by Juan J. Badimon, Gines Escolar and M. Urooj Zafar
J. Cardiovasc. Dev. Dis. 2022, 9(12), 437; https://doi.org/10.3390/jcdd9120437 - 06 Dec 2022
Cited by 11 | Viewed by 4769
Abstract
Despite major advancements in the development of safer and more effective anticoagulant agents, bleeding complications remain a significant concern in the treatment of thromboembolic diseases. Improvements in our understanding of the coagulation pathways highlights the notion that the contact pathway—specifically factor XI (FXI)—has [...] Read more.
Despite major advancements in the development of safer and more effective anticoagulant agents, bleeding complications remain a significant concern in the treatment of thromboembolic diseases. Improvements in our understanding of the coagulation pathways highlights the notion that the contact pathway—specifically factor XI (FXI)—has a greater role in the etiopathogenesis of thrombosis than in physiological hemostasis. As a result, a number of drugs targeting FXI are currently in different stages of testing and development. This article aims to review the different strategies directed towards FXI-inhibition with a brief summation of the agents in clinical development, and to comment on the therapeutic areas that could be explored for potential indications. Therapeutics targeting FXI/FXIa inhibition have the potential to usher in a new era of anticoagulation therapy. Full article
(This article belongs to the Special Issue New Insights into Antithrombotic Therapy for Cardio- and Cerebrovascular Disease: From Molecular Mechanisms to Clinical Application)
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21 pages, 1150 KiB  
Review
Novel Antithrombotic Agents in Ischemic Cardiovascular Disease: Progress in the Search for the Optimal Treatment
by Ignacio Barriuso, Fernando Worner and Gemma Vilahur
J. Cardiovasc. Dev. Dis. 2022, 9(11), 397; https://doi.org/10.3390/jcdd9110397 - 16 Nov 2022
Cited by 4 | Viewed by 2920
Abstract
Ischemic cardiovascular diseases have a high incidence and high mortality worldwide. Therapeutic advances in the last decades have reduced cardiovascular mortality, with antithrombotic therapy being the cornerstone of medical treatment. Yet, currently used antithrombotic agents carry an inherent risk of bleeding associated with [...] Read more.
Ischemic cardiovascular diseases have a high incidence and high mortality worldwide. Therapeutic advances in the last decades have reduced cardiovascular mortality, with antithrombotic therapy being the cornerstone of medical treatment. Yet, currently used antithrombotic agents carry an inherent risk of bleeding associated with adverse cardiovascular outcomes and mortality. Advances in understanding the pathophysiology of thrombus formation have led to the discovery of new targets and the development of new anticoagulants and antiplatelet agents aimed at preventing thrombus stabilization and growth while preserving hemostasis. In the following review, we will comment on the key limitation of the currently used antithrombotic regimes in ischemic heart disease and ischemic stroke and provide an in-depth and state-of-the-art overview of the emerging anticoagulant and antiplatelet agents in the pipeline with the potential to improve clinical outcomes. Full article
(This article belongs to the Special Issue New Insights into Antithrombotic Therapy for Cardio- and Cerebrovascular Disease: From Molecular Mechanisms to Clinical Application)
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19 pages, 1638 KiB  
Review
P2Y12 Inhibitor Monotherapy after Percutaneous Coronary Intervention
by Xuan Zhou, Dominick J. Angiolillo and Luis Ortega-Paz
J. Cardiovasc. Dev. Dis. 2022, 9(10), 340; https://doi.org/10.3390/jcdd9100340 - 06 Oct 2022
Cited by 3 | Viewed by 3562
Abstract
In patients with acute and chronic coronary artery disease undergoing percutaneous coronary intervention (PCI), dual antiplatelet therapy (DAPT) has been the cornerstone of pharmacotherapy for the past two decades. Although its antithrombotic benefit is well established, DAPT is associated with an increased risk [...] Read more.
In patients with acute and chronic coronary artery disease undergoing percutaneous coronary intervention (PCI), dual antiplatelet therapy (DAPT) has been the cornerstone of pharmacotherapy for the past two decades. Although its antithrombotic benefit is well established, DAPT is associated with an increased risk of bleeding, which is independently associated with poor prognosis. The improvement of the safety profiles of drug-eluting stents has been critical in investigating and implementing shorter DAPT regimens. The introduction into clinical practice of newer generation oral P2Y12 inhibitors such as prasugrel and ticagrelor, which provide more potent and predictable platelet inhibition, has questioned the paradigm of standard DAPT durations after coronary stenting. Over the last five years, several trials have assessed the safety and efficacy of P2Y12 inhibitor monotherapy after a short course of DAPT in patients treated with PCI. Moreover, ongoing studies are testing the role of P2Y12 inhibitor monotherapy immediately after PCI in selected patients. In this review, we provide up-to-date evidence on the efficacy and safety of P2Y12 inhibitor monotherapy after a short period of DAPT compared to DAPT in patients undergoing PCI as well as outcomes associated with P2Y12 inhibitor monotherapy compared to aspirin for long-term prevention. Full article
(This article belongs to the Special Issue New Insights into Antithrombotic Therapy for Cardio- and Cerebrovascular Disease: From Molecular Mechanisms to Clinical Application)
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Other

13 pages, 1532 KiB  
Systematic Review
Left Atrial Appendage Thrombosis and Oral Anticoagulants: A Meta-Analysis of Risk and Treatment Response
by Yun-Yung Cheng, Shennie Tan, Chien-Tai Hong, Cheng-Chang Yang and Lung Chan
J. Cardiovasc. Dev. Dis. 2022, 9(10), 351; https://doi.org/10.3390/jcdd9100351 - 13 Oct 2022
Cited by 5 | Viewed by 2264
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 [...] Read more.
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. Full article
(This article belongs to the Special Issue New Insights into Antithrombotic Therapy for Cardio- and Cerebrovascular Disease: From Molecular Mechanisms to Clinical Application)
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