Why is this study important?

• Acute left ventricular thrombus (LVT) is a serious complication of myocardial infarction occurring in 2.7% (207 of 7,471) of all STEMI patients and in 9.1% (282 of 3,447) of those with anterior STEMI. 
• It poses a significant risk of embolic events and death. 
• Warfarin, a vitamin K antagonist (VKA), is the recommended first-line therapy for this indication but has several limitations. 
• Direct oral anticoagulants (DOACs), offering several advantages over warfarin, are increasingly used in LVT.  

What question was this study supposed to answer?

Acute Myocardial Infarction (RIVAWAR) trial is an investigator-initiated, single-center, open-label, randomized controlled trial designed to evaluate the efficacy and safety of rivaroxaban (20 mg once daily dose ) against warfarin (with target international normalized ratio [INR] 2-3) for 3 months in patients with acute LVT following acute myocardial infarction (MI) with a total Number 261 patients. 

What did the study show? 

• In patients with post-MI LVT, rivaroxaban demonstrated similar efficacy to warfarin in resolving LVT at three-month follow-up, with complete resolution of LVT in >95% of patients in both groups. 
• There was no evidence of excess harm in terms of mortality, ischemic stroke, or major bleeding. 
• These findings support rivaroxaban as a viable alternative (non-inferior) to warfarin, offering predictable dosing and eliminating the need for routine INR monitoring in patients with post-MI LVT.