Rivaroxaban versus warfarin for the management of left ventricle thrombus
Tóm tắt
Rivaroxaban has been recently introduced for the management of non-valvular intra-cardiac thrombosis with variable results. We aimed to compare the results of the off-label use of rivaroxaban versus warfarin in the management of patients with left ventricle (LV) thrombus. This research is a retrospective study conducted on 63 patients who had LV thrombus from January to December 2016. We compared patients treated with warfarin (
The median duration of treatment was 9.5 (25th-75th percentiles: 6-32.5) months for rivaroxaban and 14 (3-41) months for warfarin. Thrombus resolution occurred in 24 patients in the warfarin group (68.6%) and 20 patients in the rivaroxaban group (71.4%). The median time to resolution in the warfarin group was 9 (4-20) months and 3 (2-11.5) months in the rivaroxaban group. Thrombus resolution was significantly faster in patients on rivaroxaban (
Rivaroxaban was as effective and safe as warfarin in managing patients with left ventricle thrombus. Larger randomized clinical trials are recommended to confirm our findings.
Từ khóa
Tài liệu tham khảo
Makrides CA (2016) Resolution of left ventricular postinfarction thrombi in patients undergoing percutaneous coronary intervention using rivaroxaban in addition to dual antiplatelet therapy. BMJ Case Rep. 2016
Bahmaid RA, Ammar S, Al-Subaie S, Soofi MA, Mhish H, Yahia MA. Efficacy of direct oral anticoagulants on the resolution of left ventricular thrombus-a case series and literature review. Vol. 8, JRSM cardiovascular disease. England; 2019. p. 2048004019839548.
Degheim G, Berry A, Zughaib M. Off label use of direct oral anticoagulants for left ventricular thrombus. Is it appropriate? Vol. 7, American journal of cardiovascular disease. United States; 2017. p. 98–101.
McCarthy CP, Vaduganathan M, McCarthy KJ, Januzzi Jr JL, Bhatt DL, McEvoy JW. Left ventricular thrombus after acute myocardial infarction: screening, prevention, and treatment. JAMA Cardiol [Internet]. 2018 1;3(7):642–9. Available from: https://doi.org/10.1001/jamacardio.2018.1086
Bhatnagar UB, Rezkalla J, Sethi P, Stys A. Successful resolution of a large left ventricular thrombus with rivaroxaban therapy after acute myocardial infarction. Vol. 71, South Dakota medicine: the journal of the South Dakota State Medical Association. United States; 2018. p. 62–3.
Abdelnaby M, Almaghraby A, Abdelkarim O, Saleh Y, Hammad B, Badran H (2019) The role of rivaroxaban in left ventricular thrombi. Anatol J Cardiol. 21(1):47–50. https://doi.org/10.14744/AnatolJCardiol.2018.48313
Mehran R, Rao SV, Bhatt DL, Gibson CM, Caixeta A, Eikelboom J et al. Standardized bleeding definitions for cardiovascular clinical trials. Circulation [Internet]. 2011 123(23):2736–47. Available from: https://doi.org/10.1161/CIRCULATIONAHA.110.009449
Nakasuka K, Ito S, Noda T, Hasuo T, Sekimoto S, Ohmori H et al (2014) Resolution of left ventricular thrombus secondary to tachycardia-induced heart failure with rivaroxaban. Case Rep Med. 2014:814524
Esteve-Pastor MA, Orenes-Pinero E, Roldan V, Lacunza-Ruiz J, Valdes M, Marin F. Intra-ventricular thrombus resolution after anticoagulation therapy with rivaroxaban in patient with poor anticoagulation quality. Vol. 25, Cardiology journal. Poland; 2018. p. 151–4.
Leow AS-T, Sia C-H, Tan BY-Q, Loh JP-Y (2018) A meta-summary of case reports of non-vitamin K antagonist oral anticoagulant use in patients with left ventricular thrombus. J Thromb Thrombolysis. 46(1):68–73. https://doi.org/10.1007/s11239-018-1656-8
Gaznabi S, Abugroun A, Mahbub H, Campos E. Successful resolution of a large left atrial and left atrial appendage thrombus with rivaroxaban. Vol. 2019, Case reports in cardiology. United States; 2019. p. 6076923.
Ke H-H, He Y, Lv X-W, Zhang E-H, Wei Z, Li J-Y (2019 Aug) Efficacy and safety of rivaroxaban on the resolution of left atrial/left atrial appendage thrombus in nonvalvular atrial fibrillation patients. J Thromb Thrombolysis. 48(2):270–276. https://doi.org/10.1007/s11239-019-01876-z
Robinson AA, Trankle CR, Eubanks G, Schumann C, Thompson P, Wallace RL, et al. Off-label use of direct oral anticoagulants compared with warfarin for left ventricular thrombi. JAMA Cardiol [Internet]. 2020 5(6):685–692. Available from: https://doi.org/10.1001/jamacardio.2020.0652
Jones DA, Wright P, Alizadeh MA, Fhadil S, Rathod KS, Guttmann O, et al. The use of novel oral anti-coagulant’s (NOAC) compared to vitamin K antagonists (warfarin) in patients with left ventricular thrombus after acute myocardial infarction (AMI). Eur Hear journal Cardiovasc Pharmacother. 2020
Bass ME, Kiser TH, Page RL 2nd, McIlvennan CK, Allen LA, Wright G, et al. Comparative effectiveness of direct oral anticoagulants and warfarin for the treatment of left ventricular thrombus. J Thromb Thrombolysis. 2021
Fleddermann AM, Hayes CH, Magalski A, Main ML (2019) Efficacy of direct acting oral anticoagulants in treatment of left ventricular thrombus. Am J Cardiol. 124(3):367–372. https://doi.org/10.1016/j.amjcard.2019.05.009
Albabtain MA, Alharthi MM, Dagriri K, Arafat AA, Ayrout E, Alhebaishi Y, AlFagih A (2020) Assessment of the quality of anticoagulation management with warfarin in a tertiary care center. Saudi Med J. 41(11):1245–1251. https://doi.org/10.15537/smj.2020.11.25456
Maniwa N, Fujino M, Nakai M, Nishimura K, Miyamoto Y, Kataoka Y, Asaumi Y, Tahara Y, Nakanishi M, Anzai T, Kusano K, Akasaka T, Goto Y, Noguchi T, Yasuda S (2018) Anticoagulation combined with antiplatelet therapy in patients with left ventricular thrombus after first acute myocardial infarction. Eur Heart J. 39(3):201–208. https://doi.org/10.1093/eurheartj/ehx551
Sumaya W, Wallentin L, James SK, Siegbahn A, Gabrysch K, Bertilsson M, et al. Fibrin clot properties independently predict adverse clinical outcome following acute coronary syndrome: a PLATO substudy. Eur Heart J [Internet]. 2018 39(13):1078–1085. Available from: https://doi.org/10.1093/eurheartj/ehy013