DrMKZ

Study notes

For post-MI LV thrombus, the traditional ESC recommendation has been anticoagulation with warfarin (usually 3–6 months, guided by repeat imaging).

However, newer evidence supports use of DOACs like Xarelto (rivaroxaban).
Key rivaroxaban data:

RIVAWAR trial (2025)
Compared rivaroxaban vs warfarin in acute post-MI LV thrombus.
Similar thrombus resolution at 12 weeks (~96% both groups)
Faster early resolution with rivaroxaban at 4 weeks
Similar bleeding and mortality rates �
JACC +1
Earlier evidence mainly consisted of:
case reports,
observational studies,

R-DISSOLVE prospective study showing high LV thrombus resolution rates with rivaroxaban. �
PMC +2

Current practical interpretation:
DOACs (including rivaroxaban) are now increasingly accepted alternatives to warfarin for LV thrombus after MI, especially if INR monitoring is difficult.
Evidence is improving, but warfarin still has the longest guideline history.
Most clinicians repeat echo/CMR at ~3 months before stopping anticoagulation.
Typical rivaroxaban regimen used in studies:
20 mg daily (or 15 mg daily if renal impairment), usually alongside antiplatelet therapy post-PCI, with bleeding risk carefully assessed.