Abstract | AIM: METHODS AND RESULTS: This was an observational study of 2328 consecutive patients undergoing coronary angiography ± percutaneous coronary intervention (PCI) for AMI between May 2015 and December 2018, at a UK cardiac centre. Patients' details were collected from the hospital electronic database. The primary endpoint was rate of LV thrombus resolution with bleeding rates a secondary outcome. Left ventricular thrombus was diagnosed in 101 (4.3%) patients. Sixty patients (59.4%) were started on VKA and 41 patients (40.6%) on NOAC therapy ( rivaroxaban: 58.5%, apixaban: 36.5%, and edoxaban: 5.0%). Both groups were well matched in terms of baseline characteristics including age, previous cardiac history (previous myocardial infarction, PCI, coronary artery bypass grafting), and cardiovascular risk factors ( hypertension, diabetes, hypercholesterolaemia). Over the follow-up period (median 2.2 years), overall rates of LV thrombus resolution were 86.1%. There was greater and earlier LV thrombus resolution in the NOAC group compared to patients treated with warfarin (82% vs. 64.4%, P = 0.0018, at 1 year), which persisted after adjusting for baseline variables (odds ratio 1.8, 95% confidence interval 1.2-2.9). Major bleeding events during the follow-up period were lower in the NOAC group, compared with VKA group (0% vs. 6.7%, P = 0.030) with no difference in rates of systemic thromboembolism (5% vs. 2.4%, P = 0.388). CONCLUSION: These data suggest improved thrombus resolution in post- acute coronary syndrome (ACS) LV thrombosis in patients treated with NOACs compared to VKAs. This improvement in thrombus resolution was accompanied with a better safety profile for NOAC patients vs. VKA-treated patients. Thus, provides data to support a randomized trial to answer this question.
|
Authors | Daniel A Jones, Paul Wright, Momin A Alizadeh, Sadeer Fhadil, Krishnaraj S Rathod, Oliver Guttmann, Charles Knight, Adam Timmis, Andreas Baumbach, Andrew Wragg, Anthony Mathur, Sotiris Antoniou |
Journal | European heart journal. Cardiovascular pharmacotherapy
(Eur Heart J Cardiovasc Pharmacother)
Vol. 7
Issue 5
Pg. 398-404
(09 21 2021)
ISSN: 2055-6845 [Electronic] England |
PMID | 32730627
(Publication Type: Journal Article, Observational Study, Research Support, Non-U.S. Gov't)
|
Copyright | Published on behalf of the European Society of Cardiology. © The Author(s) 2020. |
Chemical References |
- Anticoagulants
- Vitamin K
- Warfarin
|
Topics |
- Administration, Oral
- Anticoagulants
(adverse effects)
- Humans
- Myocardial Infarction
(complications, diagnosis)
- Percutaneous Coronary Intervention
(adverse effects)
- Thrombosis
(diagnosis, drug therapy, etiology)
- Vitamin K
- Warfarin
(adverse effects)
|