*For medical professionals only
“img class=”responsive ” sizes=”(min-width: 320px) 320px, 100vw” src=”https://mmbiz.qpic.cn/mmbiz_png/x5F5KAyDKw19I4VvcibrfNia7lD1fial5KribXqZxjxMxtoc3ichKKz6ib3w5kJias8QNRBYGn80MM0AxEgOvRLib>p>width=”6400″ >Myocardial infarction and its complications are the most common causes of cardiovascular death. Left ventricular thrombus (LVT) often occurs after anterior myocardial infarction, and is associated with decreased cardiac function and relapse of heart failure. Major adverse cardiovascular and cerebrovascular events such as admission, stroke and death are closely related.
At present, despite the widespread development of emergency coronary intervention, the incidence of LVT after anterior myocardial infarction has decreased significantly, and major adverse cardiovascular and cerebrovascular events have also occurred. significantly reduce. However, the incidence of LVT after anterior myocardial infarction remains at 4%-12%, which is directly related to poor prognosis.
Prophylactic treatment of LVT after anterior myocardial infarction has become an important scientific issue. Studies have found that anticoagulants including warfarin not only have no clear clinical benefit, but also greatly increase bleeding risk. It is of great clinical significance to seek an effective treatment plan for preventing LVT after anterior myocardial infarction.
Recently, JACC Cardiovasc Interv published a study, which found that the experimental group with low-dose rivaroxaban was added to the control group with dual antiplatelet (DAPT) alone. Compared with the two groups, the formation of LVT was significantly reduced, the clinical net adverse events were also significantly reduced, and the systemic embolic events were also consistently reduced, revealing a new clinical treatment plan for the effective prevention of acute anterior posterior LVT. Let’s take a look together.
Research Methods
In this single center, open Label, in a randomized controlled clinical study,
279 patients with acute anterior myocardial infarction who received emergency PCI were randomly assigned,
Divided into low-dose rivaroxaban (2.5mg, twice a day, for 30 days) combined with DAPT group or DAPT alone group.
The primary endpoint was LV thrombus formation within 30 days,
The secondary endpoint was net adverse clinical events, including all-cause mortality, LVT, systemic embolism, rehospitalization for cardiovascular events, or bleeding.
Findings
compared to DAPT alone ,
low-dose rivaroxaban significantly reduced the incidence of left ventricular thrombus (1 vs.12, HR: 0.08),
< p>There was a similar reduction in the net adverse clinical event endpoint (HR: 0.37; 95% CI: 0.17-0.90; P=0.01),
concurrent systemic embolic events There was also a consistent reduction (1 vs 4; HR: 0.49; 95% CI: 0.09-2.69; P=0.42).
Conclusions
The results of this study support that short-term addition of low-dose rivaroxaban to DAPT can prevent the formation of LVT in patients with anterior ST-segment elevation myocardial infarction after direct percutaneous coronary intervention . Larger, multi-institutional studies are necessary to determine its generalizability.
Source:
Prophylactic Rivaroxaban Therapy for Left Ventricular Thrombus After Anterior ST-Segment Elevation Myocardial Infarction. JACC Cardiovasc Interv. 2022 Apr 25;15(8):861-872. doi: 10.1016/j.jcin.2022.01.285
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