Efficacy Of Rivaroxaban Versus Warfarin In Patients With Acute Left Ventricular Thrombus Following Myocardial Infarction: RIVAWAR Trial
Efficacy Of Rivaroxaban Versus Warfarin In Patients With Acute Left Ventricular Thrombus Following Myocardial Infarction: RIVAWAR Trial:
Presenter: Jehangir Shah, MD (Karachi, Pakistan)
Date: March 2025
Reference: ACC.25 Scientific Session.
Key Points Summary
1. Study Background:
The RIVAWAR trial evaluated rivaroxaban versus warfarin for treatment of left ventricular thrombus (LVT) in patients post-myocardial infarction (MI), a condition traditionally treated with VKAs like warfarin.
2. Methods:
• Phase 4, single-center, open-label RCT
• 261 patients with post-MI LVT
• Randomized 2:1 to rivaroxaban 20 mg daily or warfarin (target INR 2–3) for 3 months
• Primary endpoint: LVT resolution on echocardiography
• Secondary endpoints: all-cause mortality, MI, stroke, major bleeding
3. Main Results:
• At 1 month: LVT resolution occurred in 20.1% (rivaroxaban) vs. 8.3% (warfarin)
• At 3 months: LVT resolution in 95.8% (rivaroxaban) vs. 96.6% (warfarin)
• No significant difference in secondary outcomes: mortality, stroke, or bleeding
4. Conclusion:
Rivaroxaban was as effective as warfarin in resolving LVT by 3 months, with comparable safety. These results suggest rivaroxaban is a practical alternative to warfarin, especially considering ease of use and no need for INR monitoring.
