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Current Vascular Pharmacology

Editor-in-Chief

ISSN (Print): 1570-1611
ISSN (Online): 1875-6212

Research Article

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

Author(s): Jing Liang, Zhijian Wang, Yujie Zhou*, Hua Shen, Meng Chai, Xiaoteng Ma, Hongya Han, Qiaoyu Shao and Qiuxuan Li

Volume 20, Issue 6, 2022

Published on: 25 October, 2022

Page: [517 - 526] Pages: 10

DOI: 10.2174/1570161120666221003104821

Price: $65

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.

Keywords: Left ventricular thrombus, direct oral anticoagulants, warfarin, ST-segment elevation myocardial infarction, percutaneous coronary intervention, acute myocardial infarction.

Graphical Abstract
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