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Randomized Controlled Trial
. 2022 Apr 25;15(8):861-872.
doi: 10.1016/j.jcin.2022.01.285. Epub 2022 Mar 30.

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

Zhongfan Zhang  1 , Daoyuan Si  1 , Qian Zhang  1 , Lina Jin  2 , Haikuo Zheng  1 , Ming Qu  3 , Miao Yu  1 , Zhenya Jiang  1 , Delin Li  1 , Souping Li  1 , Ping Yang  1 , Yuquan He  1 , Wenqi Zhang  4
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Free article
Randomized Controlled Trial

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

Zhongfan Zhang et al. JACC Cardiovasc Interv. .
Free article

Abstract

Objectives: The aim of this study was to investigate the effects of rivaroxaban on left ventricle thromboprophylaxis in patients with anterior ST-segment elevation myocardial infarction (STEMI).

Background: Anterior STEMI is associated with an increased risk of left ventricular thrombus (LVT) formation. The contemporary role of prophylactic rivaroxaban therapy remains unclear.

Methods: We randomly assigned 279 patients with anterior STEMI who had undergone primary percutaneous coronary intervention to receive, in a 1:1 ratio, low-dose rivaroxaban (2.5 mg twice daily for 30 days) and dual antiplatelet therapy (DAPT) or only DAPT. The primary efficacy outcome was the LVT formation within 30 days. Net clinical adverse events were assessed at 30 days and 180 days, including all-cause mortality, LVT, systemic embolism, rehospitalization for cardiovascular events, and bleeding.

Results: The addition of low-dose rivaroxaban to DAPT reduced LVT formation within 30 days compared with only DAPT (0.7% vs 8.6%; HR: 0.08; 95% CI: 0.01-0.62; P = 0.015; P < 0.001 for superiority). Net clinical adverse events were lower within 30 days in the rivaroxaban group versus those in the only DAPT group and remained relatively low throughout the follow-up period. There were no significant differences in bleeding events between the 2 groups in 30 days and 180 days. However, 1 case of intracranial hemorrhage (major bleeding) occurred in the rivaroxaban group within 30 days.

Conclusions: Our results supported that the short-duration addition of low-dose rivaroxaban to DAPT could prevent LVT formation in patients with anterior STEMI following primary percutaneous coronary intervention. A larger multiple-institution study is necessary to determine the generalizability.

Keywords: anterior ST-segment elevation myocardial infarction; left ventricular thrombus; prophylactic anticoagulation; rivaroxaban.

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Conflict of interest statement

Funding Support and Author Disclosures This work was supported by grants from the Science and Technology Project of Jilin Provincial Department of Education (JJKH20190062KJ) and Science and Technology of Jilin Province (20210204199YY and 20200801076GH). This trial was approved by the Ethical Review Board of China-Japan Union Hospital of Jilin University (approval no. 2019071611) and was registered in the Chinese Clinical Trial Registry (https://www.chictr.org.cn [ChiCTR1900026249]). The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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