Daily 10 mg rivaroxaban as a therapy for ventricular thrombus related to left ventricular non-compaction cardiomyopathy

Sun, Huan; Zhao, Qini; Wang, Yanjing; Lakin, Robert; Feng, Haiyan; Fan, Xingyu; Huiling, Luo; Gao, Dingsan; Liu, Lin; He, Yan; Yang, Ping

doi:10.1097/md.0000000000009670

Cited by 22 publications

(11 citation statements)

References 17 publications

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“…To date, NOACs are not licensed for the treatment of LV thrombus; however, there are a growing number of recently published case studies where their use in the presence of an LV thrombus has shown impressive results. These case studies include different pathologies including LV non-compaction, hypertrophic cardiomyopathy and Chagas disease, all of which showed no embolic complications and complete LV thrombus resolution from day 7 to 2 months after initiating the chosen NOAC ( 7 , 8 , 9 ). To our knowledge, the patient presented here demonstrates the largest LV thrombus to show complete and rapid resolution within 6 days from starting treatment with Apixaban.…”

Section: Discussionmentioning

confidence: 99%

The use of Apixaban for the treatment of an LV thrombus

2018

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SummaryA 42-year-old male was admitted with shortness of breath secondary to suspected heart failure and chest infection. An echocardiogram revealed a dilated and impaired left ventricle; ejection fraction 29%, with a large, mobile thrombus within the left ventricular apex. Due to the presence of liver dysfunction, vitamin K antagonists were deemed inappropriate; thus, the decision was taken to use the novel anticoagulation agent Apixaban. After 6 days of receiving Apixaban, a cardiac magnetic resonance scan was preformed, which showed complete resolution of the LV apical thrombus.Learning points:Patients with a dilated and impaired LV are at an increased risk of developing LV thrombus.A large and mobile LV thrombus is associated with an increased risk of embolic events.Vitamin K antagonists (VKAs) are often the first-line therapy for LV thrombus; however, these may be inappropriate in some patients.NOACs are advantageous in comparison to VKAs and are used to treat: non-valvular atrial fibrillation, pulmonary embolisms and used in the prevention of recurrent deep vein thrombosis in adults.To date, NOACs are not licensed for the treatment of an LV thrombus; however, there are growing evidence whereby there use has shown promise in reducing the risk of embolic events and demonstrate rapid reduction in size/full resolution of an LV thrombus.Large, randomised research trials comparing NOACs and VKAs in the treatment of LV thrombus are needed, which may lead to a change in standard clinical practice that could benefit patients.

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Section: Discussionmentioning

confidence: 99%

The use of Apixaban for the treatment of an LV thrombus

2018

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“…Ebenso ist Vorhofflimmern eine häufige Komorbidität bei LVNC, die unabhängig vom CHA 2 DS 2 -VAsc-Score einer konsequenten Antikoagulation bedarf. Historisch wird eine Cumarin-Therapie mit einem Ziel-INR von 2,0-3,0 empfohlen, jedoch werden auch vermehrt direkte orale Antikoagulanzien (DOAK) eingesetzt [34].…”

Section: Therapieunclassified

Linksventrikuläre Non-Compaction-Kardiomyopathie

Verheyen¹,

Juch²,

Ablasser³

2020

Kardiologie up2date

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“…The use of factor Xa inhibitors for stroke prevention in patients with LVNC has not been studied. Recently, Sun et al [37] reported a case of a 43-year-old man with LVNC and an intraventricular thrombus who was treated with rivaroxaban, 10 mg daily, for 3 months. Follow-up evaluation revealed that the thrombus diminished, but this outcome does not support the use of this class of medication for stroke prevention in patients with LVNC.…”

Section: Stroke Preventionmentioning

confidence: 99%

Ischemic Stroke Secondary to Left Ventricular Noncompaction

et al. 2019

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Left ventricular noncompaction (LVNC) is a rare cause of cardiomyopathy that can lead to systemic embolism and ischemic stroke. LVNC results from the arrest of ventricular myocardium compaction during embryogenesis. Multiple other cardiac complications coexist with this cardiomyopathy, and one of the potential consequences is cardioembolic events causing ischemic stroke. This condition can be underdiagnosed or misdiagnosed as hypertrophic or dilated cardiomyopathy. We report a patient who presented with recurrent embolic ischemic stroke secondary to LVNC that was overlooked on initial transthoracic echocardiographic studies. After an unremarkable laboratory workup, transesophageal echocardiogram (TEE) revealed noncompaction of the myocardium within the apex of the left ventricle, confirmed by cardiac magnetic resonance imaging (MRI). The patient was anticoagulated with warfarin and discharged to a rehabilitation facility. Increased understanding and awareness of the diagnosis, clinical manifestations, and management of LVNC are advised, particularly in patients with recurrent embolic stroke of undetermined source. Screening of all first-degree relatives with this familial condition is recommended as well, as appropriate treatment can prevent cardiac complications and sudden death.

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Daily 10 mg rivaroxaban as a therapy for ventricular thrombus related to left ventricular non-compaction cardiomyopathy

Abstract: Supplemental Digital Content is available in the text

Cited by 22 publications

References 17 publications

The use of Apixaban for the treatment of an LV thrombus

The use of Apixaban for the treatment of an LV thrombus

Linksventrikuläre Non-Compaction-Kardiomyopathie

Ischemic Stroke Secondary to Left Ventricular Noncompaction

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