SynthesisEuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology2025
Direct oral anticoagulants or warfarin in patients with left ventricular thrombus after ST-elevation myocardial infarction: a pilot trial and a prespecified meta-analysis of randomised trials.
Synthesis in EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT05705089 (Rivaroxaban vErsus Warfarin for Antithrombotic TheRapy in Patients With LeFt Ventricular Thrombus After Acute ST-Elevation Myocardial Infarction), which is not on this map. Cited by 18 papers, 3 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Rivaroxaban vErsus Warfarin for Antithrombotic TheRapy in Patients With LeFt Ventricular Thrombus After Acute ST-Elevation Myocardial Infarction: A Pilot Randomized Clinical Trial
Who cites it
18 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- Direct oral anticoagulants or warfarin in left ventricular thrombus: an updated systematic review and meta-analysis of randomized trials.Journal of thrombosis and thrombolysis · 2026Pooled it
- Pooled it
- DOACs vs Warfarin for Post-myocardial Infarction Left Ventricular Thrombus: A GRADE-assessed Meta-Analysis With Trial Sequential Analysis of Randomized Trials.Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/HemostasisPooled it
- Echocardiographic features, antithrombotic therapy, and association with outcomes in patients with left ventricular thrombus after myocardial infarction: a single-center retrospective study.Clinical research in cardiology : official journal of the German Cardiac Society · 2026Article
- Direct Oral Anticoagulants Versus Vitamin K Antagonists for Treatment of Left Ventricular Thrombus: A Review of Efficacy and Safety.Reviews in cardiovascular medicine · 2026Review
- Article
- The role of aetiology in determining anticoagulation effectiveness for the treatment of left ventricular thrombus.European heart journal. Cardiovascular pharmacotherapy · 2026Observational
- Direct oral anticoagulants versus warfarin for left ventricular thrombus: an updated systematic review and meta-analysis of randomized and observational studies.Frontiers in cardiovascular medicine · 2026Review
- Direct oral anticoagulants vs. warfarin for left ventricular thrombus.European heart journal open · 2026Article
- "DOACs for Left Ventricular Thrombus: Persistent Equipoise Despite New Observational and Randomized Data": comment.Research and practice in thrombosis and haemostasis · 2026Article
- Potential ofFrontiers in immunology · 2026Article
- Recurrent Stroke and Progression of Left Ventricular Thrombus During Apixaban Therapy in a Patient with Severe Ischemic Cardiomyopathy: A Case Report.The American journal of case reports · 2025Article
- Comparison of direct oral anticoagulants and vitamin K antagonists in the treatment of left ventricular thrombi: a retrospective cohort study.Research and practice in thrombosis and haemostasis · 2025Article
- Article
- An Updated Meta-Analysis of Randomized Controlled Trials Comparing Direct Oral Anticoagulants Against Warfarin for Left Ventricular Thrombus Resolution.Journal of clinical medicine · 2025Review
- Direct Oral Anticoagulants versus Warfarin for Left Ventricular Thrombus: A Meta-Analysis of Randomized-Controlled Trials.European journal of preventive cardiology · 2025Article
- Review
- Direct oral anticoagulants for ventricular thrombus resolution: pilot trials show reassuring efficacy and safety compared to warfarin.EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology · 2025Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
23 authors.
Funding
Abstract
backgroundThe role of direct oral anticoagulants (DOACs) in the treatment of left ventricular thrombus (LVT) after ST-elevation myocardial infarction (STEMI) remains uncertain.
aimsWe aimed to compare the effect of rivaroxaban versus warfarin in patients with STEMI complicated by LVT.
methodsAdult patients with STEMI and two-dimensional transthoracic echocardiography showing LVT were assigned to rivaroxaban (15 mg once daily) or warfarin (international normalised ratio goal of 2.0-2.5) in an open-label, randomised clinical trial (RCT). A prospective pooled analysis was planned comparing DOAC- versus warfarin-based anticoagulation for the same indication. The main outcome of the RCT was complete LVT resolution at 3 months, determined by a blinded imaging core laboratory. Complete LVT resolution and bleeding were investigated in the pooled analysis.
resultsA total of 50 patients (median age: 55 years, 18% females) were enrolled from June 2020 to November 2022. Three-month complete LVT resolution occurred in 19/25 (76.0%) patients assigned to rivaroxaban and 13/24 (54.2%) assigned to warfarin (relative risk [RR] 1.40, 95% confidence interval [CI]: 0.91-2.15; p=0.12) with no thrombotic or major bleeding events. Pooled analysis showed numerically better complete LVT resolution with DOACs (rivaroxaban and apixaban; 93/115 [80.8%] vs 79/112 [70.5%], RR 1.14, 95% CI: 0.98-1.32; p=0.08) and less major bleeding (2/116 [1.7%] and 9/112 [8.0%], risk difference -0.06, 95% CI: -0.12 to 0.00; p=0.05) than with warfarin.
conclusionsAlthough the findings are limited by a small sample size, the results suggest that DOACs are safe with at least similar outcomes concerning LVT resolution and major bleeding compared with warfarin. (ClinicalTrials.gov: NCT05705089).
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.