Comparison of Rivaroxaban Versus Warfarin in Resolution of Left Ventricular Thrombus After Acute Anterior Wall Myocardial Infarction: A Prospective Cohort Study: Rivaroxaban vs Warfarin for Left Ventricular Thrombus

Muhammad Zeshan Siddique; Abdul Majid; Jam Naveed Nawaz; Muhammad Khalid Razaq; Syed Abdullah Faiz

doi:10.54393/pjhs.v7i6.3638

Authors

Muhammad Zeshan Siddique Department of Cardiology, Sheikh Zayed Hospital, Rahim Yar Khan, Pakistan
Abdul Majid The American College of Cardiology, Washington, D.C, United Sates of America
Jam Naveed Nawaz The American College of Cardiology, Washington, D.C, United Sates of America
Muhammad Khalid Razaq Department of Cardiology, Sheikh Zayed Hospital, Rahim Yar Khan, Pakistan
Syed Abdullah Faiz Department of Cardiology, Sheikh Zayed Hospital, Rahim Yar Khan, Pakistan

DOI:

https://doi.org/10.54393/pjhs.v7i6.3638

Keywords:

Echocardiography, Myocardial Infarction, Rivaroxaban, Thrombosis, Warfarin

Abstract

There is emerging evidence that direct oral anticoagulants like rivaroxaban are a more effective alternative for thrombus resolution after acute myocardial infarction. Objective: To compare the rate of left ventricular thrombus resolution between rivaroxaban and warfarin after acute anterior wall myocardial infarction. Methods: This prospective cohort study was conducted in the Department of Cardiology at Sheikh Zayed Hospital, Rahim Yar Khan, from May to November 2025. A total of 290 participants with left ventricular thrombus after acute anterior wall myocardial infarction were enrolled in the study. The unexposed group consisted of patients treated with warfarin, with the dose adjusted to maintain an INR of 2.0-3.0. The exposed group received rivaroxaban (20 mg daily; 15 mg if creatinine clearance was 30–50 ml/min/1.73m²). Echocardiography was performed at baseline and repeated after three months to assess thrombus resolution. Data were analyzed through SPSS version 25.0. Descriptive statistics were run, and an independent sample t-test was used for numerical comparison and a chi-square test for categorical comparison. Results: The mean age was 60.4 ± 6.4 years, with 73.4% males. Baseline demographics were comparable between the groups. Thrombus resolution at three months was achieved in 52.4% overall, significantly higher in rivaroxaban versus warfarin (61.4% vs. 43.4%, p-value=0.002; RR: 1.4, 95% CI: 1.1–1.8). Diabetes, hypertension, and thrombus size ≥1 cm were associated with lower thrombus resolution rates. Conclusions: Rivaroxaban demonstrated better efficacy over warfarin for thrombus resolution in post-myocardial infarction patients. Comorbid diabetes, hypertension, and larger thrombosis size were significant negative predictors of resolution.

Author Biography

Syed Abdullah Faiz, Department of Cardiology, Sheikh Zayed Hospital, Rahim Yar Khan, Pakistan

MBBS, FCPS Cardiology

Senior Registrar

Phone: 03036663666

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