Comparison Of Effects Of Different Doses Of Rivaroxaban And Warfarin On Left Ventricular Thrombosis And Its Prognosis

ObjectiveTo compare the effects of different doses of rivaroxaban and warfarin on left ventricular thrombosis and its prognosis,and to find the best anticoagulant treatment for left ventricular thrombosis.MethodFrom January 2017 to June 2021,all the reports of continuous echocardiography in China-Japan Union Hospital of Jilin University were searched by computer for keyword sensitivity.Regardless of the underlying disease,patients diagnosed with LVT can be included in the study.All cause death,rehospitalization,embolism,bleeding,mace events and disappearance of left ventricular thrombosis were recorded.Results Of all 125 patients with LVT included in the study,73.6%（n=92）observed the disappearance of left ventricular thrombosis.In warfarin group（n=17）,low-dose rivaroxaban（n=33）,medium-dose rivaroxaban（n=32）and high-dose rivaroxaban（n =32）,the disappearance of left ventricular thrombosis was 70.6%（n=12）,69.7%（n =23）,68.8%（n=22）and 81.3%（n=26）,respectively.In the high-dose rivaroxaban group,the disappearance rate of left ventricular thrombosis reached 81.3%.Although there was no significant difference with the control group warfarin group（P = 0.632）,there was a trend of the highest dissolution rate.History of stroke（HR: 2.507;95%confidence interval: 1.378 to 4.561;P = 0.009）and smaller LVT size（HR: 0.898;95%confidence interval: 0.830 to 0.972;P = 0.008）were independently associated with the disappearance of left ventricular thrombosis.Among the patients included in the study,7 patients were observed to have bleeding.No bleeding events were observed in warfarin group.In low-dose rivaroxaban,medium-dose rivaroxaban and high-dose rivaroxaban,the number of bleeding cases were 3,3 and 1 respectively.There was no significant difference in bleeding events among the four groups（P > 0.05）.66.7%,31.3% and 28.% of the low dose,medium dose and high dose rivaroxar groups respectively Of the patients received dual antiplatelet therapy.The difference was statistically significant（P =0.002）.Moreover,we found that in low-dose rivaroxaban,all three patients with bleeding were treated with triple therapy,and one case was a major bleeding event.This may suggest that triple therapy increases the risk of bleeding.Among all patients with LVT included in the study,all-cause death,rehospitalization,embolism,mace and bleeding complications occurred in 29.6%（n =37）,27.2%（n = 34）,4.8%（n = 6）,48.0%（n = 60）and 5.6%（n = 7）,respectively.Taking warfarin group as the control group,there was no significant difference in the incidence of all-cause death,rehospitalization,embolism and mace among low-dose rivaroxaban,medium dose rivaroxaban and high-dose rivaroxaban（P ≥ 0.05）.Disappearance of LVT（HR: 0.174;95% confidence interval: 0.077 to 0.392;P =0.000）and NT pro BNP / 100（HR: 1.005;95% confidence interval: 1.021 to 1.008;P= 0.010）were independently associated with patient death.Disappearance of LVT（HR: 0.276;95% confidence interval: 0.146 to 0.521;P =0.000）and NT pro BNP / 100（HR: 1.005;95% confidence interval: 1.002 to 1.008;P= 0.001）were independently associated with mace events.Conclusion1.In this study,rivaroxaban is as safe and effective as warfarin.Although there is no priority recommendation in the current guidelines,rivaroxaban is a reasonable and convenient choice for the treatment of left ventricular thrombosis.2.During follow-up,compared with warfarin,high-dose rivaroxaban tended to have higher left ventricular thrombolysis rate and fewer mace events.3.The disappearance of LVT is an independent protective factor of all-cause death and mace events.Anticoagulant therapy can improve the clinical prognosis of patients.