Reduction of Thrombus Burden With Short-Term, Low-Dose Rivaroxaban Use in Acute Myocardial Infarction: The...

Area of Science:

• Cardiology
• Interventional Cardiology
• Pharmacology

Background:

• Managing large coronary thrombus burden (LCTB) in ST-segment-elevation myocardial infarction (STEMI) is challenging.
• Deferred stenting is a strategy for STEMI patients with LCTB, but optimal antithrombotic therapy is unclear.
• The ARISE-ARMYDA 7 trial investigated low-dose rivaroxaban in this patient group.

Purpose of the Study:

• To evaluate the efficacy and safety of adding low-dose rivaroxaban to dual antiplatelet therapy (DAPT) for LCTB reduction in STEMI patients undergoing deferred stenting.
• To assess the impact of rivaroxaban on thrombus burden reduction using optical coherence tomography (OCT).

Main Methods:

• A single-center, randomized pilot study included STEMI patients with LCTB undergoing primary PCI and deferred stenting.
• Patients received either rivaroxaban 2.5 mg BID plus aspirin and ticagrelor, or aspirin and ticagrelor alone.
• Thrombus burden was quantified by OCT at baseline and after 5-7 days; the primary endpoint was thrombus score reduction.

Main Results:

• The rivaroxaban group showed a significantly lower post-treatment thrombus score compared to controls (39 vs. 82, P=0.005).
• Relative thrombus score reduction was greater with rivaroxaban (61% vs. 36%, P=0.002), and thrombus volume decreased by 77% vs. 39% (P=0.001).
• Deferred stenting was safe; no significant differences in 30-day MACE or bleeding were observed between groups.

Conclusions:

• Adding low-dose rivaroxaban to DAPT significantly reduces thrombus burden in STEMI patients with LCTB managed with deferred stenting.
• This combination therapy appears safe, with no increase in major adverse cardiovascular events or bleeding.
• The findings support further investigation of rivaroxaban-based regimens in this high-risk population.