Takeaway
- Rivaroxaban (e.g., Xarelto) outperforms warfarin in resolving left atrial/left atrial appendage (LA/LAA) thrombus in patients with nonvalvular Afib, especially after 6 weeks of treatment.
Why this matters
- Afib-induced LA/LAA thrombus development is the major source of pulmonary embolism and increases risk for other thromboembolic events.
- Vitamin K antagonists (e.g., warfarin) are effective in preventing stroke in these patients but require continual monitoring and dose adjustments.
Key results
- With rivaroxaban: thrombin time (P<.0001 plasma prothrombin time and activated partial thromboplastin were significantly lower fibrinogen higher.>
- Also with rivaroxaban: transesophageal echocardiography showed average thrombus length (P<.0001 width and area were significantly lower after weeks of treatment.>
- No major or fatal bleeding, ischemic stroke in either group.
Study design
- Single-center randomized, controlled study from prospectively collected registry of patients with nonvalvular Afib (n=80) with LA/LAA thrombus.
- Participants were randomly allocated to rivaroxaban 20 mg/day for 12 weeks or warfarin (international normalized ratio, 2-3).
- Outcome: thrombus dissolution following treatment for 3 months, Afib-related stroke/embolism.
- Funding: Natural Science Foundation of Guangxi Province of China, others.
Limitations
- Single-center study.
- No serological marker to assess function of dissolving thrombosis.
- Relatively small left atrial volumes.
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