Abstract
Introduction: Left ventricular (LV) thrombus is a well-recognized complication of LV systolic dysfunction, especially in the setting of acute myocardial infarction. Multiple recent studies looked into the efficacy and safety of direct oral anticoagulants but limited number of studies reported outcomes in patients on rivaroxaban specifically. Hypothesis: Rivaroxaban is as effective as vitamin K antagonists (VKAs) in the treatment of LV thrombus. Methods: We conducted a meta-analysis of all studies that evaluated clinical outcomes of rivaroxaban versus warfarin in the treatment of LV thrombus. The primary outcome was thrombus resolution. Secondary outcomes included bleeding events, and systemic embolism. Results: One randomized clinical trial (RCT), and 3 retrospective observational studies with a total of 988 patients were included. Heterogeneity was low-moderate across the trials (19-54%). Thrombus resolution was numerically higher in the rivaroxaban arm but did not reach statistical significance (Rivaroxaban 80% vs VKAs 70%, p=0.57). Bleeding events (Rivaroxaban 9% vs VKAs 11%, p=0.77) and systemic embolism (Rivaroxaban 21.5% vs VKAs 30.9%, p=0.57) were both similar between the two arms (Figure). Conclusions: Rivaroxaban has similar efficacy and safety when compared to VKAs in the treatment of LV thrombus. Large RCTs are needed to confirm these results.
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