Prophylactic Rivaroxaban Therapy for Left Ventricular Thrombus After Anterior ST-Segment Elevation Myocardial Infarction

Zhang, Zhongfan; Si, Daoyuan; Zhang, Qian; Jin, Lina; Zheng, Hongyu; Qu, Ming; Yu, Miao; Jiang, Zhenya; Li, Delin; Li, Souping; Yang, Ping; He, Yan; Zhang, Wenqi

doi:10.1016/j.jcin.2022.01.285

Cited by 30 publications

(24 citation statements)

References 21 publications

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“…Recently, 1 modest-sized single-center, open-labeled randomized trial of 279 patients specifically examined whether low-dose anticoagulation (rivaroxaban 2.5 mg twice daily for 30 days) in addition to DAPT could decrease the risk of LV thrombus compared with DAPT alone. 51 The addition of low-dose rivaroxaban compared with no such therapy lowered the risk of LV thrombus formation (0.7% versus 8.6%; hazard ratio, 0.08 [95% CI, 0.01–0.62]), as well as net adverse clinical events, without increased bleeding. In addition to other limitations of the trial (eg, single center, open label), there was a high rate of patient dropout (16.5%), and >75% of patients had an LVEF>45%.…”

Section: Prevention Of LV Thrombus After Acute Mimentioning

confidence: 99%

“…In addition to other limitations of the trial (eg, single center, open label), there was a high rate of patient dropout (16.5%), and >75% of patients had an LVEF>45%. 51,52 Although a practice of routine prophylactic anticoagulation in all patients does not appear to be supported by data, consideration of the pros and cons of prophylactic anticoagulant therapy to prevent LV thrombus in this setting on a patient-by-patient basis seems prudent. If prophylactic anticoagulation is initiated after MI, we suggest a 1-to 3-month duration because the risk of LV thrombus formation is highest within the first month after MI before declining.…”

Section: Clinical Statements and Guidelinesmentioning

confidence: 99%

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Management of Patients at Risk for and With Left Ventricular Thrombus: A Scientific Statement From the American Heart Association

Levine¹,

McEvoy²,

Fang³

et al. 2022

Circulation

112

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Despite the many advances in cardiovascular medicine, decisions concerning the diagnosis, prevention, and treatment of left ventricular (LV) thrombus often remain challenging. There are only limited organizational guideline recommendations with regard to LV thrombus. Furthermore, management issues in current practice are increasingly complex, including concerns about adding oral anticoagulant therapy to dual antiplatelet therapy, the availability of direct oral anticoagulants as a potential alternative option to traditional vitamin K antagonists, and the use of diagnostic modalities such as cardiac magnetic resonance imaging, which has greater sensitivity for LV thrombus detection than echocardiography. Therefore, this American Heart Association scientific statement was commissioned with the goals of addressing 8 key clinical management questions related to LV thrombus, including the prevention and treatment after myocardial infarction, prevention and treatment in dilated cardiomyopathy, management of mural (laminated) thrombus, imaging of LV thrombus, direct oral anticoagulants as an alternative to warfarin, treatments other than oral anticoagulants for LV thrombus (eg, dual antiplatelet therapy, fibrinolysis, surgical excision), and the approach to persistent LV thrombus despite anticoagulation therapy. Practical management suggestions in the form of text, tables, and flow diagrams based on careful and critical review of actual study data as formulated by this multidisciplinary writing committee are given.

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Section: Prevention Of LV Thrombus After Acute Mimentioning

confidence: 99%

Section: Clinical Statements and Guidelinesmentioning

confidence: 99%

Management of Patients at Risk for and With Left Ventricular Thrombus: A Scientific Statement From the American Heart Association

Levine¹,

McEvoy²,

Fang³

et al. 2022

Circulation

112

View full text Add to dashboard Cite

show abstract

“…Zhang et al studied the prophylactic use of rivaroxaban for LV thrombus after anterior ST elevation MI [ 49 ]. The study comprised 279 patients who underwent PCI and were randomized in a one-to-one manner to either rivaroxaban (2.5 mg twice daily for 30 days) plus DAPT or DAPT alone.…”

Section: Doacs In LV Thrombus—the Clinical Experiencementioning

confidence: 99%

“…Thus, the use of the shortest possible course of triple therapy comprising DOACs with the further continuation of DAPT as required may be used for at-risk patients and is an area of research in such patients. However, further research is needed in this regard for strong validation [ 49 ].…”

Section: Doacs In LV Thrombus—the Clinical Experiencementioning

confidence: 99%

Anticoagulation for Left Ventricle Thrombus—Case Series and Literature Review for Use of Direct Oral Anticoagulants

Pradhan

Bhandari

Vishwakarma

et al. 2023

JCDD

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Left ventricular thrombus is a known complication following acute myocardial infarction that can lead to systemic thromboembolism. To obviate the risk of thromboembolism, the patient needs anticoagulation in addition to dual antiplatelet therapy. However, combining antiplatelets with anticoagulants substantially increases the bleeding risk. Traditionally, vitamin K antagonists (VKAs) have been the sheet anchor for anticoagulation in this scenario. The use of direct oral anticoagulants has significantly attenuated the bleeding risk associated with anticoagulation for atrial fibrillation and venous thromboembolism. Furthermore, in patients with atrial fibrillation undergoing percutaneous coronary intervention, the use of direct oral anticoagulants (DOACs) in conjunction with antiplatelets has been found to be noninferior in reducing ischemic events while significantly attenuating the bleeding compared with VKA. After initial case reports, multiple observational and nonrandomized studies have now safely and effectively utilized direct oral anticoagulants for anticoagulation in left ventricular thrombus. Here, we report a series of two cases presenting with left ventricular thrombus following acute myocardial infarction. In this case series, we try to address the issues concerning the choice and duration of anticoagulation in the case of postinfarct left ventricular thrombus. Pending the results of large randomized control trials, the judicious use of direct oral anticoagulant is warranted when taking into consideration the ischemic and bleeding profile in an individualized approach.

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“…Since nowadays much emphasis is placed on prevention, the role of DOACs has been studied in this setting as well. Low-dose rivaroxaban was added to standard DAPT in patients with anterior STEMI treated by primary PCI and it reduced the LV thrombi formation at a 30-day follow-up [ 28 ].…”

Section: The Use Of Doacs In Patients With LV Thrombusmentioning

confidence: 99%

Direct Oral Anticoagulants for Stroke and Systemic Embolism Prevention in Patients with Left Ventricular Thrombus

Bădescu

Șorodoc

Lionte

et al. 2023

JPM

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In recent years, direct oral anticoagulants (DOAC) have accumulated evidence of efficacy and safety in various clinical scenarios and are approved for a wide spectrum of indications. Still, they are currently used off-label for left ventricular thrombus owing to a paucity of evidence. For the same reason, there is a lack of guideline indication as well. Our work is based on an exhaustive analysis of the available literature and provides a structured and detailed update on the use of DOACs in patients with left ventricle thrombus. The safety and efficacy of DOACs were analyzed in particular clinical scenarios. As far as we know, this is the first paper that analyzes DOACs in this approach.

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Prophylactic Rivaroxaban Therapy for Left Ventricular Thrombus After Anterior ST-Segment Elevation Myocardial Infarction

Cited by 30 publications

References 21 publications

Management of Patients at Risk for and With Left Ventricular Thrombus: A Scientific Statement From the American Heart Association

Management of Patients at Risk for and With Left Ventricular Thrombus: A Scientific Statement From the American Heart Association

Anticoagulation for Left Ventricle Thrombus—Case Series and Literature Review for Use of Direct Oral Anticoagulants

Direct Oral Anticoagulants for Stroke and Systemic Embolism Prevention in Patients with Left Ventricular Thrombus

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