Comparing Apixaban and Warfarin for Treating Left Ventricular Blood Clots After a Heart Attack

What this Trial Is About

Researchers are studying the best anticoagulant treatment for patients who develop left ventricular LV thrombus after an acute myocardial infarction AMI. This study compares the effects of apixaban and warfarin on resolving the thrombus. The trial is a multicenter, randomized Phase 4 study sponsored by Karolinska Institutet, aiming to clarify which medication better supports thrombus resolution in this patient group. Participants are randomly assigned to receive either apixaban or warfarin. Apixaban is given as a 5 mg tablet twice daily, with a reduced dose of 2.5 mg twice daily for certain patients based on age, kidney function, or weight. Warfarin is dosed individually to reach a target blood clotting measure INR of 2.0-3.0, with initial bridging using low-molecular-weight heparin. Treatment adjustments are made according to standardized blood tests and patient conditions. During the study, participants undergo evaluations including heart imaging to check thrombus status at 3 and 12 months, and monitoring for bleeding events and major cardiovascular outcomes. The primary outcome is the number and proportion of patients with thrombus resolution at 3 months. Secondary outcomes include bleeding rates, stroke or embolism occurrence, and overall clinical events. The study lasts at least 12 months, providing ongoing safety and efficacy monitoring.

Treatment With Apixaban Versus Warfarin in Patients With Left Ventricular Thrombus After Acute Myocardial Infarction