Rivaroxaban in heart failure patients with left ventricular thrombus: A retrospective study
Background: The role of rivaroxaban in patients with heart failure (HF) combined with left ventricular (LV) thrombus remains unknown in current guideline-directed anticoagulant therapy. The aim of this study was to investigate the impact on clinical outcomes of rivaroxaban compared to vitamin K anta...
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Frontiers Media S.A.
2022-10-01
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| Series: | Frontiers in Pharmacology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fphar.2022.1008031/full |
| _version_ | 1797996399292317696 |
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| author | Qian Zhang Zhongfan Zhang Haikuo Zheng Ming Qu Shouping Li Ping Yang Daoyuan Si Wenqi Zhang |
| author_facet | Qian Zhang Zhongfan Zhang Haikuo Zheng Ming Qu Shouping Li Ping Yang Daoyuan Si Wenqi Zhang |
| author_sort | Qian Zhang |
| collection | DOAJ |
| description | Background: The role of rivaroxaban in patients with heart failure (HF) combined with left ventricular (LV) thrombus remains unknown in current guideline-directed anticoagulant therapy. The aim of this study was to investigate the impact on clinical outcomes of rivaroxaban compared to vitamin K antagonists (VKAs) in patients with HF combined with LV thrombus.Methods: We retrospectively extracted clinical, echocardiographic and follow-up data of HF patients (all classifications) admitted at China-Japan Union Hospital of Jilin University from January 2017 to June 2021. A total of 198 patients with HF were identified with LV thrombus by echocardiography, 78 of them were managed with VKAs, 109 with rivaroxaban.Results: The median follow-up was 17.0 months (interquartile range: 6.0–24.0 months). High rates of major cardiovascular adverse events (MACEs) were observed in both the rivaroxaban and VKAs groups (49.5% vs. 57.7%). However, rivaroxaban versus VKAs observed a decrease in MACEs (adjusted HR:0.636; 95%CI:0.418–0.970; p = 0.035) and systemic embolism (4.6% vs. 12.8%; adjusted HR:0.318; 95%CI:0.108–0.933; p = 0.037; Gray’s test p = 0.041) but was not found to have a benefit with regard to LV thrombus resolution (59.6% vs. 70.6%; adjusted HR: 1.303; 95% CI:0.898–1.890; p = 0.163; Gray’s test p = 0.073). Additionally, there was no significant between-group difference in the rate of International Society on Thrombosis and Hemostasis (ISTH) bleeding events.Conclusion: Our data found that in populations with HF combined with LV thrombus, the overall prognosis in both the rivaroxaban and VKAs groups was catastrophic. Although rivaroxaban improved the prognosis to some extent, a considerable need remains for new treatments to improve their clinical course. |
| first_indexed | 2024-04-11T10:15:51Z |
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| institution | Directory Open Access Journal |
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| language | English |
| last_indexed | 2024-04-11T10:15:51Z |
| publishDate | 2022-10-01 |
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| spelling | doaj.art-1dc98c906cac4cb5827527e2e2c83dfb2022-12-22T04:29:56ZengFrontiers Media S.A.Frontiers in Pharmacology1663-98122022-10-011310.3389/fphar.2022.10080311008031Rivaroxaban in heart failure patients with left ventricular thrombus: A retrospective studyQian Zhang0Zhongfan Zhang1Haikuo Zheng2Ming Qu3Shouping Li4Ping Yang5Daoyuan Si6Wenqi Zhang7Department of Cardiology, China-Japan Union Hospital of Jilin University, Changchun, ChinaDepartment of Cardiology, China-Japan Union Hospital of Jilin University, Changchun, ChinaDepartment of Cardiology, China-Japan Union Hospital of Jilin University, Changchun, ChinaDepartment of Gastroenterology, Endoscopy Center, China-Japan Union Hospital of Jilin University, Changchun, Jilin, ChinaDepartment of Cardiology, China-Japan Union Hospital of Jilin University, Changchun, ChinaDepartment of Cardiology, China-Japan Union Hospital of Jilin University, Changchun, ChinaDepartment of Cardiology, China-Japan Union Hospital of Jilin University, Changchun, ChinaDepartment of Cardiology, China-Japan Union Hospital of Jilin University, Changchun, ChinaBackground: The role of rivaroxaban in patients with heart failure (HF) combined with left ventricular (LV) thrombus remains unknown in current guideline-directed anticoagulant therapy. The aim of this study was to investigate the impact on clinical outcomes of rivaroxaban compared to vitamin K antagonists (VKAs) in patients with HF combined with LV thrombus.Methods: We retrospectively extracted clinical, echocardiographic and follow-up data of HF patients (all classifications) admitted at China-Japan Union Hospital of Jilin University from January 2017 to June 2021. A total of 198 patients with HF were identified with LV thrombus by echocardiography, 78 of them were managed with VKAs, 109 with rivaroxaban.Results: The median follow-up was 17.0 months (interquartile range: 6.0–24.0 months). High rates of major cardiovascular adverse events (MACEs) were observed in both the rivaroxaban and VKAs groups (49.5% vs. 57.7%). However, rivaroxaban versus VKAs observed a decrease in MACEs (adjusted HR:0.636; 95%CI:0.418–0.970; p = 0.035) and systemic embolism (4.6% vs. 12.8%; adjusted HR:0.318; 95%CI:0.108–0.933; p = 0.037; Gray’s test p = 0.041) but was not found to have a benefit with regard to LV thrombus resolution (59.6% vs. 70.6%; adjusted HR: 1.303; 95% CI:0.898–1.890; p = 0.163; Gray’s test p = 0.073). Additionally, there was no significant between-group difference in the rate of International Society on Thrombosis and Hemostasis (ISTH) bleeding events.Conclusion: Our data found that in populations with HF combined with LV thrombus, the overall prognosis in both the rivaroxaban and VKAs groups was catastrophic. Although rivaroxaban improved the prognosis to some extent, a considerable need remains for new treatments to improve their clinical course.https://www.frontiersin.org/articles/10.3389/fphar.2022.1008031/fullheart failureleft ventricular thrombusanticoagulation managementrivaroxabanvitamin K antagonists |
| spellingShingle | Qian Zhang Zhongfan Zhang Haikuo Zheng Ming Qu Shouping Li Ping Yang Daoyuan Si Wenqi Zhang Rivaroxaban in heart failure patients with left ventricular thrombus: A retrospective study Frontiers in Pharmacology heart failure left ventricular thrombus anticoagulation management rivaroxaban vitamin K antagonists |
| title | Rivaroxaban in heart failure patients with left ventricular thrombus: A retrospective study |
| title_full | Rivaroxaban in heart failure patients with left ventricular thrombus: A retrospective study |
| title_fullStr | Rivaroxaban in heart failure patients with left ventricular thrombus: A retrospective study |
| title_full_unstemmed | Rivaroxaban in heart failure patients with left ventricular thrombus: A retrospective study |
| title_short | Rivaroxaban in heart failure patients with left ventricular thrombus: A retrospective study |
| title_sort | rivaroxaban in heart failure patients with left ventricular thrombus a retrospective study |
| topic | heart failure left ventricular thrombus anticoagulation management rivaroxaban vitamin K antagonists |
| url | https://www.frontiersin.org/articles/10.3389/fphar.2022.1008031/full |
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