Why the study?
Vitamin K antagonists are the recommended treatment for ventricular thrombosis, but completed trials evaluating direct oral anticoagulants for this complication in acute or chronic settings are lacking.
Does low-dose apixaban added to dual antiplatelet therapy resolve post-infarctual left ventricular apical thrombosis without bleeding complications in a patient with STEMI?
Does low-dose apixaban added to dual antiplatelet therapy resolve post-infarctual left ventricular apical thrombosis without bleeding complications in a patient with STEMI?
Off-label use of low-dose apixaban combined with dual antiplatelet therapy successfully resolved a post-myocardial infarction left ventricular apical thrombus without bleeding complications.
Answers are grounded in this paper and cite their sources.
Apixaban resolved post-MI LV thrombus in one case; hypothesis-generating and requires RCTs before any practice change.
The recommended treatment for ventricular thrombosis is based on vitamin K antagonists use for at least 3 months. Till now there are not completed trials that allow use of direct oral anticoagulants for this specific complication in neither chronic nor acute settings. We report the case of a subacute left ventricular apical thrombosis complicating a myocardial infarction in a 78-years-old patient effectively treated with low-dose apixaban (2.5 mg twice daily) associated with dual antithrombotic therapy. This off-label therapeutic approach was successful and no hemorrhagic complications neither thrombotic recurrences were noticed in the acute phase and at 2-years follow up. This case is the first one describing a successful and not complicated management of post-myocardial infarction ventricular thrombosis using off-label low-dose apixaban and it encourages further evidences and studies to evaluate the possibility of using this approach in the management of this kind of issues.
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Robles et al. (2020) studied this question.
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