Low-dose rivaroxaban could prevent LVT formation in anterior STEMI patients after PCI: JACC
China: Results from a recent study support the short-duration addition of low-dose rivaroxaban to DAPT for preventing left ventricular thrombus (LVT) formation in anterior STEMI patients after percutaneous coronary intervention (PCI). The study appears in the journal JACC: Cardiovascular Interventions.
Anterior ST-elevation myocardial infarction (STEMI) is tied to an increased risk of left ventricular thrombus formation. However, there is no clarity on the contemporary role of prophylactic rivaroxaban therapy. Considering this, Zhongfan Zhang, Department of Cardiology, China-Japan Union Hospital of Jilin University, Changchun, China, and colleagues aimed to investigate the effects of rivaroxaban on the left ventricle thromboprophylaxis in patients with anterior STEMI.
For this purpose, the researchers included 279 patients with anterior STEMI who had undergone primary PCI. They were randomly assigned in the ratio of 1:1 to receive low-dose rivaroxaban (2.5 mg twice daily for 30 days) and dual antiplatelet therapy (DAPT) or only DAPT.
LVT formation within 30 days was the primary efficacy outcome. Assessment of net clinical adverse events was done at 30 days and 180 days, including all-cause mortality, LVT, systemic embolism, rehospitalization for cardiovascular events, and bleeding.
Following were the key findings of the study:
- The addition of low-dose rivaroxaban to DAPT reduced LVT formation within 30 days compared with only DAPT (0.7% vs 8.6%; HR: 0.08).
- Net clinical adverse events were lower within 30 days in the rivaroxaban group versus those in the only DAPT group and remained relatively low throughout the follow-up period.
- There were no significant differences in bleeding events between the 2 groups in 30 days and 180 days. However, 1 case of intracranial hemorrhage (major bleeding) occurred in the rivaroxaban group within 30 days.
"Short-duration addition of low-dose rivaroxaban to DAPT could prevent LVT formation in patients with anterior STEMI following primary PCI," wrote the authors. "However, there is a need for a larger multiple-institution study to determine the generalizability."
Reference:
The study titled, "Prophylactic Rivaroxaban Therapy for Left Ventricular Thrombus After Anterior ST-Segment Elevation Myocardial Infarction," was published in the journal JACC: Cardiovascular Interventions.
KEYWORDS: JACC, rivaroxaban, DAPT, STEMI, dual antiplatelet therapy, left ventricular thrombus, ST-elevation myocardial infarction, Zhongfan Zhang, anterior STEMI, percutaneous coronary intervention, cardiovascular disease, bleeding
