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Rivaroxaban vs Warfarin in Acute Left Ventricular Thrombus Following Myocardial Infarction: RIVAWAR, An Open-Label

Jehangir Ali Shah1, Jamil Hussain1, Bashir Ahmed1

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JACC. Advances
|July 24, 2025
PubMed
Summary
This summary is machine-generated.

Rivaroxaban shows similar effectiveness to warfarin in treating left ventricular thrombus (LVT) after myocardial infarction (MI). Both treatments achieved over 95% LVT resolution at 12 weeks, with comparable safety profiles.

Keywords:
anticoagulation therapyleft ventricular thrombusmyocardial infarctionnon-vitamin K antagonist oral anticoagulantsrivaroxabanwarfarin

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Area of Science:

  • Cardiology
  • Pharmacology
  • Clinical Trials

Background:

  • Warfarin, a vitamin K antagonist, is the standard treatment for left ventricular thrombus (LVT).
  • Direct oral anticoagulants like rivaroxaban offer potential advantages such as fixed dosing and no routine monitoring.
  • Increasing consideration is given to direct oral anticoagulants for LVT management.

Purpose of the Study:

  • To compare the efficacy of rivaroxaban versus warfarin in treating acute left ventricular thrombus (LVT) following myocardial infarction (MI).
  • To evaluate LVT resolution rates at 12 weeks in patients treated with rivaroxaban or warfarin.

Main Methods:

  • An open-label, noninferiority, randomized controlled trial was conducted.
  • Patients with acute LVT post-MI were randomized 2:1 to receive rivaroxaban (20 mg daily) or warfarin (target INR 2-3) for 12 weeks.
  • LVT resolution was assessed by echocardiography at 4 and 12 weeks.

Main Results:

  • A total of 261 patients were randomized; 171 received rivaroxaban and 90 received warfarin.
  • LVT resolution at 12 weeks was high and similar in both groups (95.8% for rivaroxaban vs. 96.6% for warfarin; P = 0.759).
  • All-cause mortality and major bleeding rates were comparable between the rivaroxaban and warfarin groups.

Conclusions:

  • Rivaroxaban is similarly effective to warfarin for treating post-MI LVT.
  • Both treatments demonstrate high rates of LVT resolution (>95%) at 12 weeks.
  • Further multicenter trials with extended follow-up are warranted to confirm these findings.