Direct oral anticoagulants or warfarin in patients with left ventricular thrombus after ST-elevation myocardial infarction: a pilot trial and a prespecified meta-analysis of randomised trials
Primary result · Complete LVT resolutionResult — go to the resultRelative risk 1.40 95% CI 0.91–2.15Authors' conclusion
Although the findings are limited by a small sample size, the results suggest that DOACs are safe with at least similar outcomes concerning LVT resolution and major bleeding compared with warfarin. (ClinicalTrials.gov: NCT05705089).
Study context
- Population
- Adult patients with ST-elevation myocardial infarction (STEMI) and two-dimensional transthoracic echocardiography showing left ventricular thrombus (LVT)enrolled from June 2020 to November 2022
- Participants
- 50 patients
- Comparison
- Rivaroxaban versus warfarin in patients with STEMI complicated by LVT
- Rivaroxabann = 25
- Warfarinn = 24reference
- Primary endpoint
- complete LVT resolution
- Follow-up
- 3 months
Methodological detailsRandomised clinical trial (RCT), prospective pooled analysis, blinded imaging core laboratory
- RCT
- Prospective pooled analysis
- Blinded imaging core laboratory
Primary result
As reported in the abstract
Relative risk
1.40
95% CI 0.91–2.15
P = 0.12
Events by treatment group
Rivaroxaban vs warfarin
RR 1.40 (95% CI 0.91–2.15); P = 0.12
Further findings
| Outcome | Rivaroxaban | Warfarin | RR (95% CI) | P value | |
|---|---|---|---|---|---|
| Complete LVT resolution, pooled analysis (DOACs: rivaroxaban and apixaban vs warfarin) | Not reported in the abstract | 70.5% | 1.14 (0.98–1.32) | P = 0.08 | rivaroxaban: not reported in the abstract |
| 0.512Relative risk (log scale) |
- Complete LVT resolution, pooled analysis (direct oral anticoagulants (DOACs): rivaroxaban and apixaban vs warfarin): DOACs 80.8%
Safety
| Outcome | Rivaroxaban | Warfarin | Risk difference (95% CI) | P value | |
|---|---|---|---|---|---|
| Major bleeding, pooled analysisDOACs vs warfarin · less major bleeding with DOACs | Not reported in the abstract | 8.0% | −0.06 (−0.12 to 0.00) | P = 0.05 | rivaroxaban: not reported in the abstract |
| −0.15−0.1−0.0500.05Difference (linear scale) |
- Major bleeding, pooled analysis: DOACs 1.7%
Thrombotic or major bleeding events (RCT)
- No thrombotic or major bleeding events
Original publication
Direct oral anticoagulants or warfarin in patients with left ventricular thrombus after ST-elevation myocardial infarction: a pilot trial and a prespecified meta-analysis of randomised trials. EuroIntervention. Published 6 January 2025. doi:10.
Summarised from the published abstract; every number is checked against it