Title:Efficacy and Safety of Direct Oral Anticoagulants in the Treatment of Left
Ventricular Thrombus After Acute Anterior Myocardial Infarction in
Patients Who Underwent Percutaneous Coronary Intervention
Volume: 20
Issue: 6
Author(s): Jing Liang, Zhijian Wang, Yujie Zhou*, Hua Shen, Meng Chai, Xiaoteng Ma, Hongya Han, Qiaoyu Shao and Qiuxuan Li
Affiliation:
- Department of Cardiology, Beijng Anzhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Disease, Capital Medical University, Beijing, China
Keywords:
Left ventricular thrombus, direct oral anticoagulants, warfarin, ST-segment elevation myocardial infarction, percutaneous coronary intervention, acute myocardial infarction.
Abstract:
Aims: To explore treatment with Direct Oral Anticoagulants (DOACs) in left ventricular
thrombus (LVT) after ST-segment elevation myocardial infarction (STEMI) in patients who underwent
percutaneous coronary intervention (PCI).
Background: Contemporary data regarding using DOACs for LVT after STEMI patients who underwent
PCI is limited.
Objectives: To investigate the efficacy and safety of DOACs on the treatment of LVT post STEMI and
PCI.
Methods: This retrospective study enrolled patients with LVT post STEMI and PCI within 1month from
onset who received warfarin or DOACs at discharge. The primary endpoint was LVT resolution. Secondary
endpoints were major adverse cardiovascular events (MACEs), including death, stroke, systemic
embolism (SE), myocardial infarction (MI) and major or minor bleeding.
Results: A total of 128 consecutive patients were recruited, of which 72 received warfarin and 56 DOACs
[48 on rivaroxaban and 8 on dabigatran]. The rate of LVT resolution was higher within 1 month in
the DOACs group than warfarin (26.8% vs. 11.1%; p = 0.022) (Kaplan-Meier estimates, p = 0.002). No
significant differences were found at 3 months (p = 0.246), 6 months (p = 0.201), 9 months (p = 0.171)
and 12 months (p = 0.442). No patients treated with DOACs had major bleeding, while two patients
with warfarin had upper gastrointestinal bleeding (0 vs. 2 (2.8%); p = 0.209). No death or SE occurred.
No significant differences on secondary endpoints were found in both the groups, including stroke, MI,
minor bleeding and all bleeding events.
Conclusion: DOACs appear to be a suitable alternative to warfarin for the management of LVT post
STEMI, especially in patients who are intolerant to warfarin.
