Key result
Treatment with direct oral anticoagulants in addition to dual antiplatelet therapy resulted in complete resolution of post-infarction left ventricular thrombus in all 6 patients within 6 to 12 weeks.
Why the study?
Current guidelines recommend vitamin K antagonists for post-infarction left ventricular thrombus, but off-label use of direct oral anticoagulants has dramatically increased.
Does direct oral anticoagulant therapy resolve post-infarction left ventricular thrombus?
Case Report (n=6)
No
Does direct oral anticoagulant therapy resolve post-infarction left ventricular thrombus?
In this small case series, off-label use of DOACs combined with dual antiplatelet therapy successfully resolved post-infarction left ventricular thrombus without major bleeding or embolic complications.
Hypothesis-generating for DOAC addition to DAPT in post-MI LV thrombus; should not change practice without randomized trials.
Left ventricular thrombus (LVT) is a known complication of acute myocardial infarction (AMI). Vitamin K antagonists such as Warfarin showed a reduction in associated mortality and morbidity and are indicated as anticoagulants of choice in current guidelines. Since their approval for clinical use, there has been a dramatic increase in off-label use of direct oral anti-coagulants (DOAC) for LVT. In this case series, the authors share their successful experience with DOAC in the treatment of LVT.
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Chachar et al. (2021) conducted a case report in Post-infarction left ventricular thrombus (n=6). Direct oral anticoagulants (Rivaroxaban or Apixaban) plus DAPT was evaluated on Complete resolution of left ventricular thrombus. Treatment with direct oral anticoagulants in addition to dual antiplatelet therapy resulted in complete resolution of post-infarction left ventricular thrombus in all 6 patients within 6 to 12 weeks.
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