Century Clot-Guided Prophylactic Rivaroxaban for Post STEMI Complicating Left Ventricular Thrombus
Status:
Recruiting
Trial end date:
2027-12-31
Target enrollment:
Participant gender:
Summary
To manage the ST-segment elevation myocardial infarction (STEMI) caused by plaque rupture,
triggers platelet activation/aggregation and thrombin generation, requires dual (platelet and
coagulation) pathway inhibition. However, triple antithrombotic therapy with standard dual
antiplatelet therapy (DAPT) and oral anticoagulant (OAC) in the STEMI setting is a challenge,
since that increase in potential risk of bleeding.
Although the incidence of left ventricular thrombus (LVT) formation after STEMI decreased in
modern reperfusion therapy, including primary percutaneous coronary intervention (PCI),
remains at 4% to 26%, especially that complicated by anterior STEMI. The recommendation of an
OAC prophylactic therapy for preventing LVT formation in current STEMI guidelines is limited.
How to optimize antithrombotic therapy to balance the bleeding-thrombotic profile, and
prevent LVT formation is challenging, since insufficient evidence is available from
randomized trials.
Century Clot analyzer is point-of-care testing that could assess the coagulate state: normal,
hypo-coagulable, or hyper-coagulable states according to clot rate (CR) value. Whether
Century Clot-guided rivaroxaban prophylactic therapy (2.5 mg twice daily, if the
hypercoagulable state, defined as CR ≥24) in combination with standard DAPT could reduce LVT
formation without increasing major bleeding is uncertain.