Low-Dose Rivaroxaban to Prevent Left Ventricular Thrombosis After Anterior Myocardial Infarction: The APERITIF...

Area of Science:

• Cardiology
• Clinical Trials
• Pharmacology

Background:

• Anterior acute myocardial infarction (MI) increases the risk of left ventricular (LV) thrombus formation.
• The efficacy and safety of adding oral anticoagulants to dual antiplatelet therapy (DAPT) for LV thrombus prevention post-anterior STEMI are not well-established.

Purpose of the Study:

• To evaluate if low-dose rivaroxaban added to DAPT reduces LV thrombus incidence at 1 month in anterior ST-segment elevation myocardial infarction (STEMI) patients.
• To assess the safety profile, including major and minor bleeding events, of this combined therapy.

Main Methods:

• A multicenter, open-label, blinded-endpoint randomized clinical trial involving 560 patients with anterior STEMI.
• Participants received either DAPT plus rivaroxaban (2.5 mg twice daily for 4 weeks) or DAPT alone.
• The primary endpoint was LV thrombus detection via contrast-enhanced cardiac magnetic resonance imaging at 1 month.

Main Results:

• LV thrombus was detected in 13.7% of patients receiving rivaroxaban plus DAPT versus 16.6% receiving DAPT alone (P=.34).
• No significant difference was observed in LV thrombus size or major adverse cardiovascular events between groups.
• Major bleeding events were comparable, but minor bleeding (BARC type 1) occurred more frequently in the rivaroxaban group (16.4% vs 7.2%).

Conclusions:

• Addition of low-dose rivaroxaban to DAPT did not significantly reduce LV thrombus formation in anterior STEMI patients at 1 month.
• The combination therapy led to a higher incidence of minor bleeding events.
• Findings should be interpreted cautiously due to the study's limited power; a modest effect cannot be excluded.