Background: Left ventricular thrombus (LVT) can complicate ST-Elevation myocardial infarction (STEMI) and is associated with poor outcomes. Conventional triple anticoagulation [Vitamin K Antagonists (VKA) plus dual-antiplatelet therapy (DAPT)] is the first-line therapy for LVT after STEMI. In patients with LVT following STEMI, contemporary data of triple therapy with rivaroxaban are lacking. Methods: We conducted a retrospective cohort study involving 1335 STEMI patients who underwent primary percutaneous coronary intervention (PCI). Among patients who developed LVT after STEMI, we observed differences in efficacy between rivaroxaban plus DAPT therapy and VKA plus DAPT. The time of LVT resolution was also evaluated, as well as net clinical adverse events, and rates of bleeding events. Results: In 1335 patients with STEMI, a total of 77 (5.7%) developed LVT over the follow-up period (median 25.0 months). Of the patients diagnosed with LVT, 31 patients were started on triple therapy with VKA, 33 patients on triple therapy with rivaroxaban. There was a consistent similarity in LVT resolution with rivaroxaban application compared to VKA application during the follow-up period [HR (log-rank test) 1.57(95% CI 0.89–2.77), p = 0.096; Adjusted HR 1.70(95% CI 0.90–3.22), p = 0.104]. Triple therapy with rivaroxaban showed quicker resolution than with VKA (6 months: p = 0.049; 12 months: p = 0.044; 18 months: p = 0.045). Similar risks of ISTH bleeding were not significantly different between the 2 groups [VKA 9.7% vs Rivaroxaban 6.1%, Adjusted HR 0.48 (95% CI 0.73–3.20); p = 0.444)]. Fewer net adverse clinical events (NACE) were observed in the rivaroxaban group [VKA 58.1% vs Rivaroxaban 24.2%; HR (log-rank test) 0.31(95% CI 0.14–0.68), p = 0.003; Adjusted HR 0.23(95% CI 0.09–0.57), p = 0.001]. Conclusion: In the observational study, triple therapy with rivaroxaban has similar and quicker LVT resolution in patients with LVT after STEMI, compared with triple therapy with VKA, and perhaps was associated with a better clinical benefit. Larger sample sizes and randomized controlled trials are needed to confirm this observation.

背景：左心室血栓 (LVT) 可使 ST 段抬高型心肌梗死 (STEMI) 复杂化，并与不良预后相关。常规三联抗凝[维生素 K 拮抗剂 (VKA) 加双重抗血小板治疗 (DAPT)] 是 STEMI 后 LVT 的一线治疗。在 STEMI 后的 LVT 患者中，缺乏利伐沙班三联疗法的当代数据。方法：我们进行了一项回顾性队列研究，涉及 1335 名接受原发性经皮冠状动脉介入治疗 (PCI) 的 STEMI 患者。在 STEMI 后发生 LVT 的患者中，我们观察到利伐沙班加 DAPT 治疗与 VKA 加 DAPT 的疗效差异。还评估了 LVT 消退的时间，以及净临床不良事件和出血事件的发生率。结果：在 1335 例 STEMI 患者中，共有 77 例（5. 7%）在随访期间（中位 25.0 个月）发展为 LVT。在诊断为 LVT 的患者中，31 名患者开始使用 VKA 三联疗法，33 名患者开始使用利伐沙班三联疗法。在随访期间，与 VKA 应用相比，利伐沙班应用的 LVT 分辨率具有一致的相似性 [HR（对数秩检验）1.57（95% CI 0.89-2.77），p  = 0.096；调整后的 HR 1.70（95% CI 0.90–3.22），p  = 0.104]。与 VKA 相比，利伐沙班三联疗法的缓解速度更快（6 个月：p  = 0.049；12 个月：p  = 0.044；18 个月：p  = 0.045）。两组之间类似的 ISTH 出血风险没有显着差异 [VKA 9.7% vs 利伐沙班 6.1%，调整后 HR 0.48 (95% CI 0.73–3.20)；p  = 0.444)]。在利伐沙班组中观察到更少的净不良临床事件 (NACE) [VKA 58.1% vs 利伐沙班 24.2%；HR（对数秩检验）0.31（95% CI 0.14–0.68），p  = 0.003；调整后的 HR 0.23（95% CI 0.09–0.57），p = 0.001]。结论：在观察性研究中，与 VKA 三联疗法相比，利伐沙班三联疗法在 STEMI 后 LVT 患者中具有相似且更快的 LVT 消退，并且可能与更好的临床获益相关。需要更大的样本量和随机对照试验来证实这一观察结果。