Rivaroxaban dissolves postinfarction left ventricular thrombus

Abstract

Despite early management of ST elevation myocardial infarction, prompt coronary revascularization and potent dual antiplatelet therapy, left ventricular thrombus still remains a dreaded complication especially in anterior STEMI. Little is known about the efficacy and safety of the new oral anticoagulants in the context of post STEMI left ventricular thrombus. We describe the case of a 54 old male Caucasian who developed an apical thrombus, despite a DAPT, 3 days after a triple stenting of the left anterior descending coronary artery, for a subacute STEMI. After one month of treatment using rivaroxaban, dissolution of the thrombus was evident on echocardiography. The present case report is the first to demonstrate left ventricular thrombus dissolution using NOAC in the setting of a subacute STEMI that forces an association with dual antiplatelet therapy. NOACs offer a rapid and more constant anticoagulation than vitamin K antagonists with less food interaction and do not require routine monitoring. For these reasons these molecules are potential good candidates to supplant VKA for the treatment of left ventricular thrombus, but randomized controlled trials are needed to demonstrate the advantages of the NOACs in this setting.