Resolution of Left Ventricular Thrombus By Rivaroxaban

Abstract

Intracardiac thrombus is a potentially life-threatening condition, with a high risk of embolic complications. Although vitamin K antagonists have been traditionally used for the treatment of intracardiac thrombus, they have relevant disadvantages that limit their use. Rivaroxaban is a once daily oral anticoagulant, currently indicated for the prevention of stroke and systemic embolism in patients with nonvalvular atrial fibrillation, and for the prevention and treatment of venous thromboembolism. We present the case of a 78-year-old man with nonvalvular atrial fibrillation, heart failure and creatinine clearance of 40 ml/min, anticoagulated with rivaroxaban 15 mg/day as the patient had very difficult access to hematologic controls. The transthoracic echocardiogram showed dilated left ventricle, severe left ventricular dysfunction and two images of thrombus, which disappeared after 4 weeks of treatment with rivaroxaban. To our knowledge, this is the first case reported regarding the resolution of left ventricular thrombosis with rivaroxaban.

Resolution of left ventricular postinfarction thrombi in patients undergoing percutaneous coronary intervention using rivaroxaban in addition to dual antiplatelet therapy

“…Rivaroxaban was also used for treating a case of intraventricular thrombus in Chagas disease16 and in a setting of dilated cardiomyopathy where again 15 mg/day was used 17…”

Rapid resolution of left ventricular thrombus with apixaban therapy

“… 7 , 8 Our case report demonstrates rapid resolution of LV thrombus in less than 3 months, and this was also observed in several other cases. 4 , 5 , 7 , 8 Moreover, only one other case revealed LV thrombus resolution in 1 week. 8 This implies that LV thrombus treatment with NOACs maybe of shorter duration than with VKAs if future data demonstrate consistency of these findings and NOACs are approved for this indication.…”

“…There are now several case reports that demonstrate similar findings to our case report with resolution of LV thrombus following an acute coronary syndrome with apixaban, rivaroxaban, and even dabigatran. 4 – 6 There has also been case reports of LV thrombus secondary to tachycardia-induced and hypertrophic cardiomyopathies that have been successfully treated with NOACs. 7 , 8 Our case report demonstrates rapid resolution of LV thrombus in less than 3 months, and this was also observed in several other cases.…”

Efficiency of rivaroxaban in a patient with myocardial infarction and left ventricular thrombus

“…Ривароксабан также был использован при лечении тромба в полости ЛЖ при болезни Чагаса [11] и при дила-тационной кардиомиопатии [12].…”