PDF(Pubmed)
Abstract：
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.
摘要：
背景：利伐沙班在心力衰竭（HF）合并左心室（LV）血栓患者中的作用在目前指南指导的抗凝治疗中仍然未知。这项研究的目的是研究利伐沙班与维生素K拮抗剂（VKAs）相比对HF合并LV血栓患者的临床结局的影响。方法：我们回顾性提取临床，2017年1月至2021年6月在吉林大学中日联合医院收治的HF患者（所有分类）的超声心动图和随访数据。共198例HF患者通过超声心动图发现左心室血栓。其中78个是用VKAs管理的，109与利伐沙班。结果：中位随访时间为17.0个月（四分位距：6.0-24.0个月）。在利伐沙班和VKAs组中观察到高的主要心血管不良事件（MACEs）发生率（49.5%vs.57.7%）。然而,利伐沙班与VKAs相比，观察到MACEs（调整后的HR：0.636;95CI：0.418-0.970;p=0.035）和全身性栓塞（4.6％vs.12.8%；调整后的HR：0.318；95CI：0.108-0.933；p=0.037；灰色检验p=0.041），但未发现对左心室血栓消退有益处（59.6%vs.70.6%；调整后的HR：1.303；95%CI：0.898-1.890；p=0.163；格雷检验p=0.073）。此外,国际血栓形成与止血协会(ISTH)出血事件发生率无显著组间差异.结论：我们的数据发现，在HF合并LV血栓的人群中，利伐沙班组和VKAs组的总体预后是灾难性的.虽然利伐沙班在一定程度上改善了预后，一个相当大的需要新的治疗方法，以改善其临床过程。
