Abstract
BackgroundRivaroxaban has been recently introduced for the management of non-valvular intra-cardiac thrombosis with variable results. We aimed to compare the results of the off-label use of rivaroxaban versus warfarin in the management of patients with left ventricle (LV) thrombus. This research is a retrospective study conducted on 63 patients who had LV thrombus from January to December 2016. We compared patients treated with warfarin (n=35) to patients who had rivaroxaban (n=28), and study outcomes were time to thrombus resolution, bleeding, stroke, and mortality.ResultsThe median duration of treatment was 9.5 (25th-75th percentiles: 6-32.5) months for rivaroxaban and 14 (3-41) months for warfarin. Thrombus resolution occurred in 24 patients in the warfarin group (68.6%) and 20 patients in the rivaroxaban group (71.4%). The median time to resolution in the warfarin group was 9 (4-20) months and 3 (2-11.5) months in the rivaroxaban group. Thrombus resolution was significantly faster in patients on rivaroxaban (p= 0.019). Predictors of thrombus resolution were thrombus surface area (HR: 1.21; CI 95% (1.0-1.46); p= .048) and the use of rivaroxaban (HR: 1.92; CI 95% (1.01-3.65); p= 0.048). There was no difference in stroke, bleeding, and mortality between both groups.ConclusionRivaroxaban was as effective and safe as warfarin in managing patients with left ventricle thrombus. Larger randomized clinical trials are recommended to confirm our findings.
Highlights
Rivaroxaban has been recently introduced for the management of non-valvular intra-cardiac thrombosis with variable results
All patients were on betablockers, spironolactone, and angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor blockers
Thrombus resolution occurred in 24 patients in the warfarin group (68.57%) and 20 patients in the rivaroxaban group (71.43%)
Summary
Rivaroxaban has been recently introduced for the management of non-valvular intra-cardiac thrombosis with variable results. We aimed to compare the results of the off-label use of rivaroxaban versus warfarin in the management of patients with left ventricle (LV) thrombus. This research is a retrospective study conducted on 63 patients who had LV thrombus from January to December 2016. We compared patients treated with warfarin (n=35) to patients who had rivaroxaban (n=28), and study outcomes were time to thrombus resolution, bleeding, stroke, and mortality. Intracardiac thrombus is a potentially life-threatening condition with a high risk of embolic complications [1]. The traditional anticoagulant for intracardiac thrombus is vitamin K antagonists. They were replaced recently in specific conditions with direct oral anticoagulants (DOAC) [2]. DOACs have several advantages over warfarin, including predictable kinetics and no need for continuous monitoring [3].
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