Rivaroxaban versus warfarin for the management of left ventricle thrombus

Abstract

Background Rivaroxaban has been recently introduced for the management of non-valvular intra-cardiac thrombosis with variable results. We aimed to compare the results of the off-label use of rivaroxaban versus warfarin in the management of patients with left ventricle (LV) thrombus. This research is a retrospective study conducted on 63 patients who had LV thrombus from January to December 2016. We compared patients treated with warfarin (n=35) to patients who had rivaroxaban (n=28), and study outcomes were time to thrombus resolution, bleeding, stroke, and mortality. Results The median duration of treatment was 9.5 (25th-75th percentiles: 6-32.5) months for rivaroxaban and 14 (3-41) months for warfarin. Thrombus resolution occurred in 24 patients in the warfarin group (68.6%) and 20 patients in the rivaroxaban group (71.4%). The median time to resolution in the warfarin group was 9 (4-20) months and 3 (2-11.5) months in the rivaroxaban group. Thrombus resolution was significantly faster in patients on rivaroxaban (p= 0.019). Predictors of thrombus resolution were thrombus surface area (HR: 1.21; CI 95% (1.0-1.46); p= .048) and the use of rivaroxaban (HR: 1.92; CI 95% (1.01-3.65); p= 0.048). There was no difference in stroke, bleeding, and mortality between both groups. Conclusion Rivaroxaban was as effective and safe as warfarin in managing patients with left ventricle thrombus. Larger randomized clinical trials are recommended to confirm our findings.

Direct oral anticoagulants for the treatment of left ventricular thrombosis: an updated systematic review and meta-analysis

“…1). Twelve studies were contemporary observational trials, 14–25 and two were small RCTs 26,27 . Thirteen studies reported data on the occurrence of LVT resolution, 14,15,18,19,22–30 11 on the occurrence of stroke 14,15,19,21,22,24–28,30 and 12 on the occurrence of bleedings 14,15,18,19,21–27,30 …”

“…Twelve studies were contemporary observational trials, [14][15][16][17][18][19][20][21][22][23][24][25] and two were small RCTs. 26,27 Thirteen studies reported data on the occurrence of LVT resolution, 14,15,18,19,[22][23][24][25][26][27][28][29][30] 11 on the occurrence of stroke 14,15,19,21,22,[24][25][26][27][28]30 and 12 on the occurrence of bleedings. 14,15,18,19,[21][22][23][24][25][26][27]30 Main outcome Overall, 1332 patients were included in the analysis for the primary outcome.…”

A Meta-Analysis Comparing Different Oral Anticoagulation for the Treatment of Ventricular Thrombus

“…No stroke or embolism events were observed, and only one patient experienced nonfatal bleeding. Numerous studies claimed that NOACs were comparable with or even outweighed VKAs [28,[33][34][35][36][37]39,40,[45][46][47], and obviously the most popular or dominant usage of NOACs was rivaroxaban in all studies. It was known that NOACs could be divided into two types targeting various action mechanismanti-Xa inhibitor (rivaroxaban, apixaban and edoxaban or anti-IIa inhibitors (dabigatran).…”

“…Nine articles were deleted due to the inaccessibility of full-text (n = 8) and uncomplete data (n = 1). Finally, we included a total of 18 eligible studies for meta-analysis (17 for retrospective study and one for prospective study) [25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42].…”

“…Observational durations ranged from 3 to 172 months, eight of which lasted for 12 months or even longer [27][28][29]38,40,41] (Table 1, Ref. [25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42]). Among 1755 patients included, 65% of patients (n = 1148) received VKAs and 35% of patients (n = 607) received NOACs.…”