Key result
Low-dose rivaroxaban added to DAPT reduces LV thrombus formation by ~12 percentage points in post-STEMI patients.
Why the study?
Left ventricular thrombus is a serious complication after STEMI, especially with reduced LV systolic function, and the efficacy of adding low-dose rivaroxaban to DAPT for its prevention was evaluated.
Does adding low-dose rivaroxaban to standard dual antiplatelet therapy prevent left ventricular thrombus formation in patients with STEMI and LVEF <40% compared to dual antiplatelet therapy alone?
RCT (n=174)
Computer-generated 1:1
No
Does adding low-dose rivaroxaban to standard dual antiplatelet therapy prevent left ventricular thrombus formation in patients with STEMI and LVEF <40% compared to dual antiplatelet therapy alone?
Absolute Event Rate: 5.7% vs 17.2%
p-value: p=0.021
Adding low-dose rivaroxaban (2.5 mg twice daily) to standard dual antiplatelet therapy safely and significantly reduces the incidence of early left ventricular thrombus formation in STEMI patients with severely reduced ejection fraction.
Supports adding low-dose rivaroxaban to DAPT in STEMI with LVEF<40% to reduce LV thrombus; extends limited RCT data but needs larger trials for clinical outcomes.
Background: Left ventricular thrombus (LVT) is a serious complication of ST-segment elevation myocardial infarction (STEMI), especially in patients with reduced left ventricular systolic function. This study aimed to evaluate the efficacy and safety of low-dose rivaroxaban in addition to dual antiplatelet therapy (DAPT) for prevention of LVT formation after STEMI. Methodology: This randomized controlled trial was conducted at the Department of Cardiology, Jinnah Hospital Lahore, over six months. A total of 174 patients with acute STEMI and left ventricular ejection fraction <40% were enrolled and randomly divided into two equal groups. Group A (n=87) received standard DAPT, while Group B (n=87) received rivaroxaban 2.5 mg twice daily in addition to DAPT. Follow-up transthoracic echocardiography was performed after 30 days to assess LVT formation. Results: LVT developed in 15 patients (17.2%) in Group A compared with 5 patients (5.7%) in Group B (p=0.021). Patients with ejection fraction ≤30% showed significantly higher rates of LVT formation. Minor bleeding events were comparable between groups, while major bleeding complications were rare. Conclusion: Low-dose rivaroxaban added to standard DAPT significantly reduced LVT formation without increasing major bleeding complications, suggesting a safe and effective preventive strategy in high-risk STEMI patients.
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Saddique et al. (2025) conducted an RCT in Acute ST-segment elevation myocardial infarction (STEMI) with left ventricular systolic dysfunction (n=174). Rivaroxaban plus Dual Antiplatelet Therapy (DAPT) vs. Dual Antiplatelet Therapy (DAPT) alone was evaluated on Development of left ventricular thrombus (LVT) at 30 days (p=0.021). Low-dose rivaroxaban added to DAPT significantly reduced left ventricular thrombus formation compared to DAPT alone (5.7% vs 17.2%, p=0.021) in STEMI patients with reduced ejection fraction.
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