Rivaroxaban resulted in complete left ventricular thrombus resolution at 3 months in 76.0% of patients compared to 54.2% with warfarin (RR 1.40; 95% CI 0.91-2.15; p=0.12).
RCT (n=50)
Open-label
Does rivaroxaban improve complete left ventricular thrombus resolution at 3 months compared to warfarin in patients with STEMI complicated by LVT?
Rivaroxaban 15 mg daily showed a non-significant trend toward improved LVT resolution at 3 months compared to warfarin in post-STEMI patients, with a favorable safety profile.
Relative Risk: 1.4 (95% CI 0.91–2.15)
Absolute Event Rate: 76% vs 54.2%
p-value: p=0.12
BACKGROUND: The role of direct oral anticoagulants (DOACs) in the treatment of left ventricular thrombus (LVT) after ST-elevation myocardial infarction (STEMI) remains uncertain. AIMS: We aimed to compare the effect of rivaroxaban versus warfarin in patients with STEMI complicated by LVT. METHODS: Adult patients with STEMI and two-dimensional transthoracic echocardiography showing LVT were assigned to rivaroxaban (15 mg once daily) or warfarin (international normalised ratio goal of 2.0-2.5) in an open-label, randomised clinical trial (RCT). A prospective pooled analysis was planned comparing DOAC- versus warfarin-based anticoagulation for the same indication. The main outcome of the RCT was complete LVT resolution at 3 months, determined by a blinded imaging core laboratory. Complete LVT resolution and bleeding were investigated in the pooled analysis. RESULTS: A total of 50 patients (median age: 55 years, 18% females) were enrolled from June 2020 to November 2022. Three-month complete LVT resolution occurred in 19/25 (76.0%) patients assigned to rivaroxaban and 13/24 (54.2%) assigned to warfarin (relative risk RR 1.40, 95% confidence interval CI: 0.91-2.15; p=0.12) with no thrombotic or major bleeding events. Pooled analysis showed numerically better complete LVT resolution with DOACs (rivaroxaban and apixaban; 93/115 80.8% vs 79/112 70.5%, RR 1.14, 95% CI: 0.98-1.32; p=0.08) and less major bleeding (2/116 1.7% and 9/112 8.0%, risk difference -0.06, 95% CI: -0.12 to 0.00; p=0.05) than with warfarin. CONCLUSIONS: Although the findings are limited by a small sample size, the results suggest that DOACs are safe with at least similar outcomes concerning LVT resolution and major bleeding compared with warfarin. (ClinicalTrials.gov: NCT05705089).
Jenab et al. (Mon,) conducted a rct in Left ventricular thrombus after ST-elevation myocardial infarction (n=50). Rivaroxaban vs. Warfarin was evaluated on Complete LVT resolution at 3 months (RR 1.40, 95% CI 0.91-2.15, p=0.12). Rivaroxaban resulted in complete left ventricular thrombus resolution at 3 months in 76.0% of patients compared to 54.2% with warfarin (RR 1.40; 95% CI 0.91-2.15; p=0.12).