Resolution of left ventricular postinfarction thrombi in patients undergoing percutaneous coronary intervention using rivaroxaban in addition to dual antiplatelet therapy

Abstract

Left ventricular (LV) thrombus is usually seen in situations with reduced LV function, and is mostly seen in patients with large anterior ST-elevation myocardial infarction (MI). Most embolic events, in patients with LV thrombus formation, occur within the first 3–4 months, thus the recommendations regarding the duration of anticoagulant therapy. According to guidelines, an oral vitamin K antagonist, warfarin, is being used as an anticoagulant for this period. Novel oral anticoagulants were found to be either non-inferior or superior compared with warfarin in prevention of thromboembolism in patients with non-valvular atrial fibrillation. However, the data about their role in the management of LV thrombus are limited to case reports. Here, we report on the dissolution of LV apical thrombus in 3 patients with anterior ST-elevation MI receiving dual antiplatelet therapy and rivaroxaban on a reduced dose for 3 months.

Use of direct oral anticoagulants in the treatment of left ventricular thrombi: A tertiary center experience and review of the literature

“…It was also associated with lower rates of gastrointestinal bleeding and lower bleeding rates across age‐groups . Makrides CA demonstrated that short‐duration Rivaroxaban at a low dose (15 mg/d) in combination with a dual antiplatelet therapy (DAPT) was effective for the treatment of left ventricular (LV) thrombus in patients with acute coronary syndromes and drug‐eluting stent implantation, and at low to intermediate bleeding risk . Resolution of LVT can be confirmed by follow‐up TTE .…”

Large Left Ventricular Thrombus as a Cause of Recurrent Cardioembolic Stroke While on Dabigatran

“…Despite these findings, the utility of DOAC therapy for the treatment of LV thrombus has not been fully elucidated. The majority of the evidence that support use of DOAC therapy originate from case reports, 8 , 9 , 10 , 11 but there are no randomized studies or case reports involving large and mobile clots. The use of apixaban, 8 rivaroxaban, 9 and dabigatran 10 has been cited in a few case reports of LV thrombus resolution, but notably, the majority of the clot burden was <2 cm in size.…”

Safety and Efficacy of Triple Therapeutic Targets with Rivaroxaban after Acute Myocardial Infarction Complicated by Left Ventricular Thrombi in a Case of Nonvalvular Atrial Fibrillation

“…The optimal antithrombotic strategy for patients with NVAF and ACS undergoing PCI is still controversial, and the role of NOACs in this setting is poorly documented [ 10 – 14 ].…”

“…Yet, the evidence about their role in combination with antiplatelet agents in the management of LV thrombi for ACS patients undergoing PCI is poor, and mostly limited to case reports. Hence, their efficacy can be only extrapolated [ 10 – 13 ]. At present, two randomized trials (PIONEER AF-PCI and RE-Dual PCI) [ 14 , 15 ] have demonstrated that the use of NOACs plus a P2Y12 inhibitor was associated with a lower rate of clinically significant bleeding, compared to VKAs plus dual antiplatelet therapy, thus ensuring a dual target of ischemic and thromboembolic protection against coronary and cerebrovascular events.…”