Why the study?
Does reduced-dose rivaroxaban added to dual antiplatelet therapy improve dissolution of left ventricular apical thrombus in patients with anterior ST-elevation myocardial infarction?
Does reduced-dose rivaroxaban added to dual antiplatelet therapy improve dissolution of left ventricular apical thrombus in patients with anterior ST-elevation myocardial infarction?
Reduced-dose rivaroxaban added to dual antiplatelet therapy may be an effective alternative to warfarin for the dissolution of left ventricular thrombi following anterior ST-elevation myocardial infarction.
Hypothesis-generating for reduced-dose rivaroxaban plus DAPT in post-STEMI LV thrombus; leaves open need for RCTs before practice change.
Left ventricular (LV) thrombus is usually seen in situations with reduced LV function, and is mostly seen in patients with large anterior ST-elevation myocardial infarction (MI). Most embolic events, in patients with LV thrombus formation, occur within the first 3-4 months, thus the recommendations regarding the duration of anticoagulant therapy. According to guidelines, an oral vitamin K antagonist, warfarin, is being used as an anticoagulant for this period. Novel oral anticoagulants were found to be either non-inferior or superior compared with warfarin in prevention of thromboembolism in patients with non-valvular atrial fibrillation. However, the data about their role in the management of LV thrombus are limited to case reports. Here, we report on the dissolution of LV apical thrombus in 3 patients with anterior ST-elevation MI receiving dual antiplatelet therapy and rivaroxaban on a reduced dose for 3 months.
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Constantinos Makrides (2016) studied this question.
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