Clinical Study Of Rivaroxaban In The Prevention Of Left Ventricular Thrombosis In Patients With Acute Anterior Wall Myocardial Infarction

Background Due to the advance of the drug and the reperfusion therapy technology strategy,the survival of patients with acute myocardial infarction(AMI)has been improved significantly.However,acute myocardial infarction related complications are still a prominent clinical problem.Left ventricular thrombosis(LVT)is a common complication of AMI and can lead to severe thromboembolic events.Currently,it is believed that extensive anterior wall myocardial infarction is one of the high risk factors for left ventricular thrombosis,and LVT can form within 24 hours after acute myocardial infarction,with the highest incidence within 2 weeks.The consequences of embolization caused by left ventricular thrombosis are serious,and there may be greater benefits if the drug is given in advance in high-risk groups.However,there is still controversy among various guidelines for preventing left ventricular thrombosis,and there is no stand-ard plan.At present,the commonly used treatment for left ventricular thrombosis is triple antithrombotic therapy,that is,two anti-platelet aggregation drugs combined with anticoagulant drugs.In the past,the use of warfarin anticoagulant triple antithrombotic therapy has been associated with a higher risk of bleeding.However,the traditional anticoagulation treatment with warfarin triple antithrombotic therapy has a higher risk ofbleeding.In recent years,several studies have shown that new oral anticoagulants(NOACs)combined with antithrombotic therapy are no less effective than the traditional triple therapy of warfarin,with a lower risk of bleeding.However,evidence of efficacy and safety in preventing left ventricular thrombosis is still lacking at present.Rivaroxaban,as a new oral anticoagulant,plays a highly effective anticoagulant effect by directly inhibiting coagulation factor X,which has been proved to have no significant effect on the antiplatelet aggregation effect of dual antiplatelet therapy.It also showed superior efficacy and safety to warfar-in in preventing left ventricular thrombosis in patients with atrial fibrillation.But the-re is no prospective clinical evidence to support rivaroxaban in the prevention of left ventricular thrombosis.Methods Patients with acute anterior wall myocardial infarction who met the inclusion criteria were divided into rivaroxaban group and control group by random number table method.After admission,patients in both groups were initially treated with DAPT combined with LMWH anticoagulation therapy.After that,rivaroxaban group: LMWH anticoagulant therapy was discontinued during the hospital period,rivaroxaban(2.5mg 2 / day)was added with double antiplatelet therapy(aspirin 100 mg + clopidogrel75 mg or aspirin 100 mg + tigravil 90mg),triple therapy for 1 month,and double antiplatelet therapy for 11 months.Control group: low molecularweight heparin anticoagulant therapy was discontinued during the hospital period,and dual antiplatelet therapy(aspirin 100mg+ clopidogrel75 mg or aspirin 100mg+ tigravil 90mg)was used for 12 months.And then transthoracic echocardiography was completed in all patients 7 days after PCI and 1 month after PCI,and left ventricular thrombosis was observed.The 1-month follow-up also included history,routine examination of the cardiovascular system,electrocardiogram,laboratory examination,and adverse events(endpoint events,side effects).Results The results of clinical data analysis showed that there were no statistically significant differences between the two groups in age,sex,BMI,hypertension,diabetes,smoking history,cardiac function status,coronary interventional therapy and combined cardiovascular medication Minimal dose rivaroxaban combined with dual antiplatelet therapy can effectively reduce the incidence of left ventricular thrombosis after acute anterior wall myocardial infarction,and there is no significant difference in the incidence of bleeding events.Meanwhile,the incidence of adverse events of thrombosis is significantly reduced,and the comprehensive incidence of clinical death and adverse events of thrombosis is significantly reduced.Conclusions1.The efficacy of minimal dose rivaroxaban combined with dualantiplatelet therapy in the prevention of left ventricular thrombosis after acute anterior wall myocardial infarction is clear,which can significantly reduce the incidence of left ventricular thrombosis.2.Minimal dose of rivaroxaban combined with dual antiplatelet therapy significantly reduced the incidence of thrombotic adverse events,with statistically significant differences.3.Minimal dose of rivaroxaban combined with dual antiplatelet therapy significantly reduced the combined incidence of death and thrombotic adverse events.4.There was no statistically significant difference in the incidence of total bleeding events in rivaroxaban combined with dual antiplatelet therapy at minimal dose.In conclusion,rivaroxaban is safe and effective for the prevention of left ventricular thrombosis after anterior wall myocardial infarction.