Gilles Soulat: Low-Dose Rivaroxaban Plus DAPT for LV Thrombus Prevention After Anterior STEMI
Gilles Soulat, Professor of Radiology at Paris Cité University, shared a post on LinkedIn about a recent article he and his colleagues co-authored, adding:
“Excited to share that our latest research, the APERITIF Randomized Clinical Trial, has just been published in JAMA Cardiology!
Left ventricular (LV) thrombus remains a serious concern following anterior acute myocardial infarction.
The clinical community has long debated the risk-benefit ratio of adding an oral anticoagulant to dual antiplatelet therapy (DAPT) to prevent this complication.
We set out to test this specifically.
What we did:
We conducted a multicenter randomized trial across 29 centers in France, enrolling 560 patients with anterior STEMI. Patients were randomized to receive ether DAPT alone or DAPT plus low-dose rivaroxaban (2.5 mg twice daily) for 4 weeks. To ensure the highest acuracy, we assessed the primary endpoint, the presence of LV thrombus, using contrast-enhanced cardiac magnetic resonance (CMR) imaging at 1 month.
Key Findings:
- Thrombus Incidence: We detected LV thrombus in 13.7% of patients receiving rivaroxaban and 16.6% receiving DAPT alone. This difference (-2.9%) was not statistically significant.
- Safety Profile: While major bleeding events were comparable between both groups, minor bleeding was significantly higher in the group receiving DAPT plus rivaroxaban (16.4% vs. 7.2%)
The Takeaway:
Ultimately, the addition of low-dose rivaroxaban to DAPT did not demonstrate a statistically significant reduction in LV thrombus formation at 1 month, but it did increase the risk of minor bleeding. Because event rates were slightly lower than expected, limiting the study’s statistical power, we cannot completely rule out a modest effect—so these findings should be interpreted with that nuance in mind.
I am incredibly proud to have contributed to this work under the leadership of Etienne Puymirat, and with an outstanding team of co-investigators nested within the FRENCHIE registry.”
Title: Low-Dose Rivaroxaban to Prevent Left Ventricular Thrombosis After Anterior Myocardial Infarction: The APERITIF Randomized Clinical Trial
Authors: Etienne Puymirat, Gilles Soulat, Benoit Lattuca, Claire Bouleti, Nicolas Delarche, François Roubille, Yves Cottin, Didier Bression, Nicolas Combaret, Edouard Gerbaud, Thibaut Lhermusier, Loic Biere, Olivier Dubreuil, Elie Mousseaux, Philippe Gabriel Steg, Guillaume Cayla, Gilles Lemesle, Johanne Silvain, Jean-Guillaume Dillinger, Jean-Louis Georges, Grégory Ducrocq, Thibaud Genet, Jean-François Morelle, Gilles Montalescot, Laurence Berard, Alexandra Rousseau, Maxime Soen, Tabassome Simon, Nicolas Danchin
Read the Full Article on JAMA Cardiology.
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