Why the study?
Does rivaroxaban added to DAPT resolve LV thrombus in a patient with STE-ACS?
Does rivaroxaban added to DAPT resolve LV thrombus in a patient with STE-ACS?
Rivaroxaban added to DAPT may be an effective alternative to warfarin for resolving LV thrombus following STE-ACS.
Hypothesis-generating for rivaroxaban plus DAPT in post-ACS LV thrombus; should not change practice pending controlled trials.
The incidence of left ventricular (LV) thrombi in the setting of an anterior myocardial infarction has declined significantly since the advent of primary percutaneous coronary intervention coupled with contemporary antithrombotic strategies in ST-segment elevation myocardial infarctions (STE-ACS). Despite oral anticoagulation with the currently accepted, standard-of-care vitamin K antagonist, warfarin, major bleeding complications still arise. Rivaroxaban is a novel, direct oral factor X anticoagulant that has several advantageous properties, which can attenuate bleeding risk. We present a case in which a patient successfully underwent a 3-month course of rivaroxaban in addition to his dual antiplatelet regimen of aspirin and ticagrelor for his STE-ACS and LV thrombus with resultant complete dissolution.
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Seecheran et al. (2017) studied this question.