To Compare the Efficacy of Rivaroxaban with Nicoumolone in the Management of Patients with Intraventricular Thrombus

To Compare the Efficacy of Rivaroxaban with Nicoumolone in the Management of Patients with Intraventricular Thrombus

Jagadeesh Chandra Bose Yannam, Naga Spandana Battula, Siva Sankar Annangi, Boochibabu Mannuva, Srikanth Nathani,Rajendra Betham, Akif Ahamad Baig, Kireet Ratan Nallamothu, Ashwini Kolichala

Department of Cardiology, Guntur Medical College, Guntur, Andhra Pradesh, India.

 DOI 10.25259/IJCDW_28_2024 

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ABSTRACT 


Objectives: Left ventricular thrombus (LVT) poses serious risks, including stroke and systemic embolism. Anticoagulant therapy is crucial, yet uncertainty persists in optimal management. This study aims to compare nicoumalone and rivaroxaban for LVT, assessing efficacy, safety, and monitoring considerations to inform clinical decision-making. 


Materials and Methods: This prospective and open-label trial compared rivaroxaban and nicoumalone efficacy in managing LVT over a 1-year period (September 2021–September 2022). Thirty-one patients from Government General Hospital, Guntur, meeting inclusion criteria were enrolled. Data were collected through interviews and echocardiography. Primary outcomes included thrombus resolution and recurrence; secondary outcomes encompassed adverse effects such as bleeding and stroke. Standard dosing and monitoring protocols were followed for each intervention. 


Results: In this study, both nicoumalone and rivaroxaban groups exhibited a reduction in LVT size over time, although not statistically significant (P > 0.05). Complete resolution was achieved in 70.0% of nicoumalone patients and 81.8% of rivaroxaban patients, with no significant difference (P = 0.472). However, rivaroxaban group patients achieved complete resolution significantly faster (176.67 ± 43.589 days) compared to nicoumalone group patients (271.67 ± 115.24 days) (P = 0.028). Notably, one nicoumalone patient experienced LVT recurrence post-anticoagulation cessation. 


Conclusion: Rivaroxaban was discovered to be non-inferior to nicoumolone in terms of efficacy and safety in patients with LVT. 


Keywords: Left ventricular clotrivaroxaban, NOACs, Nicoumolone, Anticoagulation, Rivaroxaban