Comparison Of New Oral Anticoagulants And Vitamin K Antagonists In Patients With Left Ventricular Thrombus After Myocardial Infarction

Objective: Left ventricular thrombus(LVT)is one of the most common complications in patients with acute myocardial infarction(AMI),and LVT is also one of the important factors affecting the prognosis of patients with acute myocardial infarc tion,the purpose of this paper is to investigate the correlation between left ventricular thrombus and systemic embolism,and identify the efficacy and safety of new oral anticoagulants(NOACs)and vitamin K antagonists in patients with left ventricular thrombus,and the most optimal time for anticoagulant drugs.Methods: We collected medical records of patients with left ventricular thrombus after acute my-ocardial infarction who attended at people's Hospital of Xinjiang Uygur Autonomo us Region and the First Affiliated Hospital of Xinjiang Medical University from Ja nuary 2012 to December 2017.At the same time,patients with acute myocardial i n-farction but without left ventricular thrombus were randomly selected as the contr olgroup.We investigate clinical characteristics,incidence of systemic embolism(S E),and association between left ventricular thrombus and embolic events,while inv es-tigate the efficacy and safety of NOACs and vitamin K antagonists.Finally,we e-xplored the most optimal time for anticoagulant drugs in patients with left ventr ic-ular thrombus.Results: Finally,136 patients with LVT after acute myocardial in fa-rction and 216 patients with acute myocardial infarction without LVT involved i n the study.During a median follow-up period of 33.8 months(interquartile range1-72 years),systemic embolism occurred in 23 patients(16.91%)in LVT group and systemic embolism occurred in 11 patients(5.09%)in the non-LVT group.,The re a-re statistically significant difference between LVT group and non-LVT group(HR 5.8 95%CI 1.51-8.98,P < 0.0001).Among the patients in LVT group,There were70 patients accepted warfarin therapy,and 56 accepted rivaroxaban therapy.Dur ing the follow-up peroid 12 patients in the warfarin group(17.1%)occurred system ic embolism,and 2 patients(3.6%)occurred systemic embolism in the rivaroxaban gro-up.There are significant difference between two groups(17.1% vs 3.6% HR 2.138 95%CI,1.086-3.974,p=0.029).As for bleeding event,a total of 11 patients oc cu-rred bleeding in warfarin group(15.7%),and there were 5 patients in rivaroxaba n group occurred bleeding event(8.9%).There were no statistically difference betwe enthe two groups(HR1.14 95%CI 0.832-1.245,p=0.32).Conclusion: LVT is an ind ep-endent risk factor for systemic embolism.Compared with vitamin K antagonists,ri-varoxaban can reduce the incidence of embolism on the basis of no increase of bleeding risk,and the longer the duration of anticoagulation,the smaller the proba bility of embolism events.