Randomized Controlled Trial of Rivaroxaban Plus Dual Antiplatelet Therapy versus Dual Antiplatelet Therapy Alone for Prevention of Left Ventricular Thrombus Formation after Acute Myocardial Infarction

Abstract

Background: Left ventricular thrombus (LVT) is a serious complication of ST-segment elevation myocardial infarction (STEMI), especially in patients with reduced left ventricular systolic function. This study aimed to evaluate the efficacy and safety of low-dose rivaroxaban in addition to dual antiplatelet therapy (DAPT) for prevention of LVT formation after STEMI. Methodology: This randomized controlled trial was conducted at the Department of Cardiology, Jinnah Hospital Lahore, over six months. A total of 174 patients with acute STEMI and left ventricular ejection fraction <40% were enrolled and randomly divided into two equal groups. Group A (n=87) received standard DAPT, while Group B (n=87) received rivaroxaban 2.5 mg twice daily in addition to DAPT. Follow-up transthoracic echocardiography was performed after 30 days to assess LVT formation. Results: LVT developed in 15 patients (17.2%) in Group A compared with 5 patients (5.7%) in Group B (p=0.021). Patients with ejection fraction ≤30% showed significantly higher rates of LVT formation. Minor bleeding events were comparable between groups, while major bleeding complications were rare. Conclusion: Low-dose rivaroxaban added to standard DAPT significantly reduced LVT formation without increasing major bleeding complications, suggesting a safe and effective preventive strategy in high-risk STEMI patients.