Key result
Rivaroxaban 15 mg twice daily for 8 weeks resulted in complete resolution of left atrial appendage thrombus in 46.7% of patients with non-valvular atrial fibrillation in whom standard therapy failed.
Why the study?
Some patients with AF develop LAA thrombus despite standard once-daily rivaroxaban, prompting evaluation of an increased twice-daily dose for thrombus lysis.
Does rivaroxaban 15 mg twice daily improve resolution of left atrial appendage thrombus in patients with non-valvular atrial fibrillation who have persistent thrombus on standard once-daily therapy?
Does rivaroxaban 15 mg twice daily improve resolution of left atrial appendage thrombus in patients with non-valvular atrial fibrillation who have persistent thrombus on standard once-daily therapy?
Rivaroxaban 15 mg twice daily may be a safe and effective strategy to dissolve LAA thrombus in patients with non-valvular AF when standard once-daily rivaroxaban therapy is ineffective.
Twice-daily rivaroxaban may resolve persistent LAA thrombus; hypothesis-generating and requires randomized trials before any practice change.
INTRODUCTION: Rivaroxaban is a direct factor Xa inhibitor used once a day for prevention of thrombotic events in patients with atrial fibrillation (AF). However, in a small proportion of subjects thrombus in the left atrial appendage (LAA) is present despite this treatment. The aim of this study was assess the efficacy of increased dose of rivaroxaban (15 mg twice daily) treatment for lysis of thrombus in the LAA. MATERIAL AND METHODS: In the RIVA-TWICE prospective, open label study, with non-blinded patients and blinded outcome assessors, rivaroxaban 15 mg twice daily for 8 weeks was administered in patients with AF who had LAA thrombus despite standard 20 mg once a day therapy. Transesophageal echocardiography was performed at baseline and after 8 weeks. Blood samples were taken to measure the activity of the anti-Xa factor. RESULTS: Fifteen patients (9 males, mean age: 63 ±10 years) were enrolled. Following 8 weeks of rivaroxaban 15 mg twice daily, complete resolution of thrombus in the LAA was observed in 7 (46.7%) patients. The mean activity of anti-Xa factor was significantly higher during rivaroxaban twice daily therapy compared with the standard dose. However, there were no significant differences between effectively and non-effectively treated patients. CONCLUSIONS: -VASc and HAS-BLED as well as preserved LAA emptying function identified responders.
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Piotrowski et al. (2019) studied Non-valvular atrial fibrillation with left atrial appendage thrombus (n=15). Rivaroxaban vs. Standard 20 mg once a day therapy (baseline) was evaluated on Complete resolution of thrombus in the left atrial appendage. Rivaroxaban 15 mg twice daily for 8 weeks resulted in complete resolution of left atrial appendage thrombus in 46.7% of patients with non-valvular atrial fibrillation in whom standard therapy failed.
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