Key result
Adding 15-day rivaroxaban to DAPT in ACS is linked to ~40% complete thrombotic lesion regression.
Why the study?
Intracoronary thrombus poses a challenging target for revascularization and significantly impacts PCI performance and outcomes, prompting evaluation of alternative management with oral anticoagulation.
Does oral rivaroxaban improve angiographic regression of coronary thrombus in patients with acute coronary syndrome managed conservatively?
Observational (n=60)
No
Does oral rivaroxaban improve angiographic regression of coronary thrombus in patients with acute coronary syndrome managed conservatively?
In a small observational cohort, oral rivaroxaban added to DAPT and statins was associated with angiographic regression of coronary thrombus in 70% of ACS patients managed conservatively.
Answers are grounded in this paper and cite their sources.
Hypothesis-generating for rivaroxaban in conservatively managed ACS with thrombus; randomized trials needed before practice change.
Introduction: The pathogenesis of acute myocardial infarction (AMI) and unstable angina is the rupture of the coronary artery plaque resulting in acute thrombotic occlusion of a coronary artery. Thus, the thrombus forms an integral part of the atherosclerotic coronary plaques. There is a consensus that intracoronary thrombus makes up a challenging target for revascularization because of its unique characteristics. It has a crucial impact on the performance and outcome of the percutaneous coronary intervention (PCI). Aims and objectives: This study reviews the alternative management of coronary artery thrombus and highlights the role of the oral anticoagulation in its management Materials and methods: We took 60 patients of ACS who underwent CAG suggestive of thrombotic occlusion of coronary arteries. They were prescribed oral anticoagulation along with DAPT and statins and check angiography were done after 15 days. Results: Out of 60 patients, 24 (40%) patients shows complete regression of thrombotic lesions, 18 (30%) patients shows regression of lesions causing decreasing in thrombotic burden, while 16 (26.6%) patients shows no regression of lesion and 2 (3.4%) patients lost to follow up. Conclusion: Oral anticoagulation can be used in thrombotic coronary occlusion.
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Deshmukh et al. (2023) conducted an observational in Acute Coronary Syndrome with thrombotic coronary artery disease (n=60). Rivaroxaban was evaluated on Complete regression of thrombotic lesions (<70% obstruction) on check coronary angiography. In patients with acute coronary syndrome and thrombotic coronary lesions, oral rivaroxaban therapy for 15 days resulted in complete regression of thrombotic lesions in 40% of patients.
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