The use of novel oral anticoagulants compared to vitamin K antagonists (warfarin) in patients with left ventricular thrombus after acute myocardial infarction

• DOI: 10.1093/ehjcvp/pvaa096
• Publication Date: 2020-07-24T11:26:41Z
• Authors: Daniel A Jones; Paul Wright; Momin A Alizadeh; Sadeer Fhadil; Krishnaraj S Rathod; Oliver Guttmann; Charles Knight; Adam Timmis; Andreas Baumbach; Andrew Wragg; Anthony Mathur; Sotiris Antoniou
• Keywords: Left Ventricular Thrombus; TIMI

Current guidelines recommend the use of vitamin K antagonist (VKA) for up to 3-6 months treatment left ventricular (LV) thrombus post-acute myocardial infarction (AMI). However, based on evidence supporting non-inferiority novel oral anticoagulants (NOAC) compared VKA other indications such as deep vein thrombosis, pulmonary embolism (PE), and thromboembolic prevention in atrial fibrillation, NOACs are being increasingly used off licence LV post-AMI. In this study, we investigated safety effect resolution patients presenting with AMI.This was an observational study 2328 consecutive undergoing coronary angiography ± percutaneous intervention (PCI) AMI between May 2015 December 2018, at a UK cardiac centre. Patients' details were collected from hospital electronic database. The primary endpoint rate bleeding rates secondary outcome. Left diagnosed 101 (4.3%) patients. Sixty (59.4%) started 41 (40.6%) NOAC therapy (rivaroxaban: 58.5%, apixaban: 36.5%, edoxaban: 5.0%). Both groups well matched terms baseline characteristics including age, previous history (previous infarction, PCI, artery bypass grafting), cardiovascular risk factors (hypertension, diabetes, hypercholesterolaemia). Over follow-up period (median 2.2 years), overall 86.1%. There greater earlier group treated warfarin (82% vs. 64.4%, P = 0.0018, 1 year), which persisted after adjusting variables (odds ratio 1.8, 95% confidence interval 1.2-2.9). Major events during lower group, (0% 6.7%, 0.030) no difference systemic thromboembolism (5% 2.4%, 0.388).These data suggest improved syndrome (ACS) thrombosis VKAs. This improvement accompanied better profile VKA-treated Thus, provides support randomized trial answer question.