Thrombus in the left atrial appendage during anticoagulant therapy with dabigatran110 mg BID resolved by rivaroxaban 15 mg QD: a case report

Abstract

A 77-year-old man on dabigatran 110 mg BID for prevention of stroke associated with nonvalvular atrial fibrillation developed transient speech disturbance for 15 min. Transesophageal echocardiographic examination demonstrated an intracardiac mobile thrombus at the left atrial appendage. We changed anticoagulant therapy from dabigatran 110 mg BID to rivaroxaban 15 mg QD. Serial transthoracic and transesophageal echocardiographic examinations showed the thrombus reducing in size, disappearing by day 13 without any recurrence of neurological deficit. For the treatment of NVAF patients with intracardiac thrombi, rivaroxaban 15 mg QD may be superior to dabigatran 110 mg BID.