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Updated: Aug 4, 2025

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Apixaban in Patients With Post-Myocardial Infarction Left Ventricular Thrombus: A Randomized Clinical Trial

Ali A Youssef1,2, Mustafa A Alrefae1, Hesham H Khalil1,3

  • 1Saud Albabtain Cardiac Centre, Dammam, Saudi Arabia.

CJC Open
|April 4, 2023
PubMed

Insights

Apixaban effectively treats left ventricular thrombus (LVT) after myocardial infarction (MI), showing non-inferiority to warfarin. This study confirms apixaban

Area of Science:

  • Cardiology
  • Pharmacology

Background:

  • Direct oral anticoagulants (DOACs) are standard for treating left ventricular thrombus (LVT) post-myocardial infarction (MI).
  • Evaluating apixaban against warfarin for post-MI LVT is crucial for treatment optimization.

Purpose of the Study:

  • To compare the efficacy and safety of apixaban versus warfarin in resolving post-MI LVT.
  • To assess LVT resolution rates and adverse events in patients receiving apixaban or warfarin.

Main Methods:

  • An open-label, randomized controlled trial involving patients with post-MI LVT confirmed by echocardiography.
  • Patients received either apixaban or warfarin alongside dual antiplatelet therapy.
  • Primary endpoint: LVT resolution at 3 months; Secondary endpoint: Major adverse cardiovascular events (MACE) and bleeding events (BARC classification).

Main Results:

  • Apixaban demonstrated non-inferiority to warfarin in LVT resolution at 3 months (76.0% vs. 80.0%, P < 0.036).
  • No significant differences in LVT resolution rates were observed at 1, 3, or 6 months between the groups.
  • Warfarin-treated patients experienced longer hospital stays and more outpatient visits; no MACE occurred, and one BARC-2 bleeding event was reported with warfarin.

Conclusions:

  • Apixaban is a safe and effective alternative to warfarin for treating post-MI LVT.
  • Apixaban offers comparable efficacy to warfarin in LVT resolution, with potential benefits in healthcare resource utilization.
Abstract

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