Takeaway
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.
Study design
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.
Key results
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).
Limitations
Small sample size; non-randomised design.
Risk of residual confounding.
This clinical summary first appeared on Univadis, part of the Medscape Professional Network.
Cite this: NOACs vs Warfarin for LV Thrombus After Acute Myocardial Infarction - Medscape - Aug 11, 2020.
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