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Current Vascular Pharmacology

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ISSN (Print): 1570-1611
ISSN (Online): 1875-6212

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Research Article

Efficacy and Safety of Direct Oral Anticoagulants in the Treatment of Left Ventricular Thrombus After Acute Anterior Myocardial Infarction in Patients Who Underwent Percutaneous Coronary Intervention

Author(s): Jing Liang, Zhijian Wang, Yujie Zhou*, Hua Shen, Meng Chai, Xiaoteng Ma, Hongya Han, Qiaoyu Shao and Qiuxuan Li

Volume 20, Issue 6, 2022

Published on: 25 October, 2022

Page: [517 - 526] Pages: 10

DOI: 10.2174/1570161120666221003104821

Price: $65

Abstract

Aims: To explore treatment with Direct Oral Anticoagulants (DOACs) in left ventricular thrombus (LVT) after ST-segment elevation myocardial infarction (STEMI) in patients who underwent percutaneous coronary intervention (PCI).

Background: Contemporary data regarding using DOACs for LVT after STEMI patients who underwent PCI is limited.

Objectives: To investigate the efficacy and safety of DOACs on the treatment of LVT post STEMI and PCI.

Methods: This retrospective study enrolled patients with LVT post STEMI and PCI within 1month from onset who received warfarin or DOACs at discharge. The primary endpoint was LVT resolution. Secondary endpoints were major adverse cardiovascular events (MACEs), including death, stroke, systemic embolism (SE), myocardial infarction (MI) and major or minor bleeding.

Results: A total of 128 consecutive patients were recruited, of which 72 received warfarin and 56 DOACs [48 on rivaroxaban and 8 on dabigatran]. The rate of LVT resolution was higher within 1 month in the DOACs group than warfarin (26.8% vs. 11.1%; p = 0.022) (Kaplan-Meier estimates, p = 0.002). No significant differences were found at 3 months (p = 0.246), 6 months (p = 0.201), 9 months (p = 0.171) and 12 months (p = 0.442). No patients treated with DOACs had major bleeding, while two patients with warfarin had upper gastrointestinal bleeding (0 vs. 2 (2.8%); p = 0.209). No death or SE occurred. No significant differences on secondary endpoints were found in both the groups, including stroke, MI, minor bleeding and all bleeding events.

Conclusion: DOACs appear to be a suitable alternative to warfarin for the management of LVT post STEMI, especially in patients who are intolerant to warfarin.

Keywords: left ventricular thrombus, direct oral anticoagulants, warfarin, ST-segment elevation myocardial infarction, percutaneous coronary intervention, acute myocardial infarction

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Graphical Abstract

[1]
Delewi R, Zijlstra F, Piek JJ. Left ventricular thrombus formation after acute myocardial infarction. Heart 2012; 98(23): 1743-9.
[http://dx.doi.org/10.1136/heartjnl-2012-301962] [PMID: 23151669]
[2]
Maniwa N, Fujino M, Nakai M, et al. Anticoagulation combined with antiplatelet therapy in patients with left ventricular thrombus after first acute myocardial infarction. Eur Heart J 2018; 39(3): 201-8.
[http://dx.doi.org/10.1093/eurheartj/ehx551] [PMID: 29029233]
[3]
Lattuca B, Bouziri N, Kerneis M, et al. Antithrombotic therapy for patients with left ventricular mural thrombus. J Am Coll Cardiol 2020; 75(14): 1676-85.
[http://dx.doi.org/10.1016/j.jacc.2020.01.057] [PMID: 32273033]
[4]
Khoury S, Carmon S, Margolis G, Keren G, Shacham Y. Incidence and outcomes of early left ventricular thrombus following ST-elevation myocardial infarction treated with primary percutaneous coronary intervention. Clin Res Cardiol 2017; 106(9): 695-701.
[http://dx.doi.org/10.1007/s00392-017-1111-4] [PMID: 28396990]
[5]
McCarthy CP, Vaduganathan M, McCarthy KJ, Januzzi JL Jr, Bhatt DL, McEvoy JW. Left ventricular thrombus after acute myocardial infarc-tion screening, prevention, and treatment. JAMA Cardiol 2018; 3(7): 642-9.
[http://dx.doi.org/10.1001/jamacardio.2018.1086] [PMID: 29800958]
[6]
Mao TF, Bajwa A, Muskula P, et al. Incidence of left ventricular thrombus in patients with acute ST-segment elevation myocardial infarction treated with percutaneous coronary intervention. Am J Cardiol 2018; 121(1): 27-31.
[http://dx.doi.org/10.1016/j.amjcard.2017.09.010] [PMID: 29128044]
[7]
Steg PG, James SK, et al. Task Force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology (ESC). ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J 2012; 33(20): 2569-19.
[8]
O’Gara PT, Kushner FG, Ascheim DD, et al. 2013 ACCF/AHA Guideline for the management of ST-elevation myocardial infarction. J Am Coll Cardiol 2013; 61(4): e78-e140.
[http://dx.doi.org/10.1016/j.jacc.2012.11.019] [PMID: 23256914]
[9]
Kernan WN, Ovbiagele B, Black HR, et al. Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2014; 45(7): 2160-236.
[http://dx.doi.org/10.1161/STR.0000000000000024] [PMID: 24788967]
[10]
Rosendaal FR, Cannegieter SC, Van Der Meer FJM, Briët E. A method to determine the optimal intensity of oral anticoagulant therapy. Thromb Haemost 1993; 69(3): 236-9.
[http://dx.doi.org/10.1055/s-0038-1651587] [PMID: 8470047]
[11]
Stratton JR, Lighty GW Jr, Pearlman AS, Ritchie JL. Detection of left ventricular thrombus by two-dimensional echocardiography: Sensitivity, specificity, and causes of uncertainty. Circulation 1982; 66(1): 156-66.
[http://dx.doi.org/10.1161/01.CIR.66.1.156] [PMID: 7083502]
[12]
Mehran R, Rao SV, Bhatt DL, et al. Standardized bleeding definitions for cardiovascular clinical trials: A consensus report from the bleeding academic research consortium. Circulation 2011; 123(23): 2736-47.
[http://dx.doi.org/10.1161/CIRCULATIONAHA.110.009449] [PMID: 21670242]
[13]
Meurin P, Brandao CV, Dumaine R, et al. Incidence, diagnostic methods, and evolution of left ventricular thrombus in patients with anterior myocardial infarction and low left ventricular ejection fraction: a prospective multicenter study. Am Heart J 2015; 170(2): 256-62.
[http://dx.doi.org/10.1016/j.ahj.2015.04.029] [PMID: 26299222]
[14]
Iqbal H, Straw S, Craven TP, Stirling K, Wheatcroft SB, Witte KK. Direct oral anticoagulants compared to vitamin K antagonist for the man-agement of left ventricular thrombus. ESC Heart Fail 2020; 7(5): 2032-41.
[http://dx.doi.org/10.1002/ehf2.12718] [PMID: 32583975]
[15]
Noflatscher M, Moes N, Gassner EM, Marschang P. Dabigatran added to dual antiplatelet therapy to treat a left ventricular thrombus in an 87 year old patient with myocardial infarction and very high bleeding risk. Front Pharmacol 2018; 9: 217.
[http://dx.doi.org/10.3389/fphar.2018.00217] [PMID: 29670522]
[16]
Bass ME, Kiser TH, Page RL II, et al. Comparative effectiveness of direct oral anticoagulants and warfarin for the treatment of left ventricular thrombus. J Thromb Thrombolysis 2021; 52(2): 517-22.
[http://dx.doi.org/10.1007/s11239-020-02371-6] [PMID: 33420896]
[17]
Honan KA, Jogimahanti A, Khair T. An updated review of the efficacy and safety of direct oral anticoagulants in treatment of left ventricular thrombus. Am J Med 2022; 135(1): 17-23.
[http://dx.doi.org/10.1016/j.amjmed.2021.07.023] [PMID: 34469758]
[18]
Kajy M, Shokr M, Ramappa P. Use of direct oral anticoagulants in the treatment of left ventricular thrombus: systematic review of current literature. Am J Ther 2020; 27(6): e584-90.
[http://dx.doi.org/10.1097/MJT.0000000000000937] [PMID: 30730331]
[19]
Verma B, Singh A, Kumar M. Use of dabigatran for treatment of left ventricular thrombus: A tertiary care center experience. J Family Med Prim Care 2019; 8(8): 2656-60.
[http://dx.doi.org/10.4103/jfmpc.jfmpc_459_19] [PMID: 31548950]
[20]
DeCampos D, Lopes J, Saleiro C, et al. Successful resolution of a large left ventricular thrombus with rivaroxaban. CASE 2020; 4(4): 270-3.
[http://dx.doi.org/10.1016/j.case.2020.04.006] [PMID: 32875194]
[21]
Cheong KI, Chuang WP, Wu YW, Huang SH. Successful resolution of left ventricular thrombus after ST-elevation myocardial infarction by edoxaban in a patient with high bleeding risk. Zhonghua Minguo Xinzangxue Hui Zazhi 2019; 35(1): 85-8.
[PMID: 30713403]
[22]
Mano Y, Koide K, Sukegawa H, Kodaira M, Ohki T. Successful resolution of a left ventricular thrombus with apixaban treatment following acute myocardial infarction. Heart Vessels 2016; 31(1): 118-23.
[http://dx.doi.org/10.1007/s00380-014-0562-z] [PMID: 25081096]
[23]
Abdelnabi M, Saleh Y, Fareed A, et al. Comparative study of oral anticoagulation in Left Ventricular Thrombi(No-LVT Trial). J Am Coll Cardiol 2021; 77(12): 1590-2.
[http://dx.doi.org/10.1016/j.jacc.2021.01.049] [PMID: 33766266]
[24]
Jones DA, Wright P, Alizadeh MA, et al. The use of novel oral anticoagulants compared to vitamin K antagonists (warfarin) in patients with left ventricular thrombus after acute myocardial infarction. Eur Heart J Cardiovasc Pharmacother 2021; 7(5): 398-404.
[http://dx.doi.org/10.1093/ehjcvp/pvaa096] [PMID: 32730627]
[25]
Daher J, Da Costa A, Hilaire C, et al. Management of left ventricular thrombi with direct oral anticoagulants: Retrospective comparative study with vitamin K antagonists. Clin Drug Investig 2020; 40(4): 343-53.
[http://dx.doi.org/10.1007/s40261-020-00898-3] [PMID: 32144651]
[26]
Ali Z, Isom N, Dalia T, et al. Direct oral anticoagulant use in left ventricular thrombus. Thromb J 2020; 18(1): 29.
[http://dx.doi.org/10.1186/s12959-020-00242-x] [PMID: 33132763]
[27]
Robinson AA, Trankle CR, Eubanks G, et al. Off-label use of direct oral anticoagulants compared with warfarin for left ventricular thrombi. JAMA Cardiol 2020; 5(6): 685-92.
[http://dx.doi.org/10.1001/jamacardio.2020.0652] [PMID: 32320043]
[28]
Ebrahimi M, Fazlinezhad A, Alvandi AM, Abdar EM. Long-term clinical outcomes of the left ventricular thrombus in patients with ST eleva-tion anterior myocardial infarction. ARYA Atheroscler 2015; 11(1): 1-4.
[PMID: 26089924]
[29]
Gibson CM, Mehran R, Bode C, et al. Prevention of bleeding in patients with atrial fibrillation undergoing PCI. N Engl J Med 2016; 375(25): 2423-34.
[http://dx.doi.org/10.1056/NEJMoa1611594] [PMID: 27959713]
[30]
Cannon CP, Bhatt DL, Oldgren J, et al. Dual antithrombotic therapy with dabigatran after PCI in atrial fibrillation. N Engl J Med 2017; 377(16): 1513-24.
[http://dx.doi.org/10.1056/NEJMoa1708454] [PMID: 28844193]
[31]
Habash F, Vallurupalli S. Challenges in management of left ventricular thrombus. Ther Adv Cardiovasc Dis 2017; 11(8): 203-13.
[http://dx.doi.org/10.1177/1753944717711139] [PMID: 28589748]

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