- Novel oral anti-coagulants (NOACs) demonstrated improved left ventricular (LV) thrombus resolution post-acute myocardial infarction (AMI) compared with vitamin K antagonist (VKA).
- Major bleeding events were lower with NOACs vs VKA (warfarin).
Why this matters
- Current guidelines recommend the use of VKA for LV thrombus post-AMI.
- However, based on evidence supporting non-inferiority of NOACs vs VKA for prevention of thromboembolic events in atrial fibrillation, NOACs are being increasingly used off licence for LV thrombus post-AMI.
- Findings warrant randomised controlled trials to confirm this observational data.
- An observational study of 2328 patients with AMI who underwent coronary angiography +/− percutaneous coronary intervention between 2015-2018.
- Primary outcome: resolution of LV thrombus.
- Secondary outcomes: bleeding events (defined by Bleeding Academic Research Consortium criteria) and thromboembolic events.
- Funding: None disclosed.
- Overall, 101 (4.3%) patients were diagnosed with LV thrombus.
- Of 101 patients, 60 (59.4%) were treated with warfarin and 41 (40.6%) with NOAC therapy (rivaroxaban, 58.5%; apixaban, 36.5%; and edoxaban, 5%).
- Overall rates of LV thrombus resolution were 86.1% over the follow-up period (median, 2.2 years).
- NOAC vs VKA group had a greater and earlier LV thrombus resolution (82% vs 64.4% at 1 year; P=.0018), which persisted after adjusting for baseline variables (OR, 1.8; 95% CI, 1.2-2.9).
- The incidence of major bleeding events was lower in the NOAC vs VKA group (0% vs 6.7%; P=.030), with no difference in rates of systemic thromboembolism (2.4% vs 5%; P=.388).
- Small sample size; non-randomised design.
- Risk of residual confounding.