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Updated: Feb 11, 2026

Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Is Rivaroxaban a Safe Choice for Apical Thrombus in Atrial Fibrillation Patients? A Case Report
Fatih Aydin1, Ozge Turgay Yildirim1, Ayse Huseyinoglu Aydin1
1Eskisehir State Hospital Cardiology Department, Eskisehir, Turkey.
Insights
Rivaroxaban effectively reduced left ventricular thrombus size in a patient with ischemic cardiomyopathy and atrial fibrillation. This novel anticoagulant offers a safe alternative when warfarin therapy is not feasible.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Left ventricular thrombi (LVT) commonly occur in akinetic left ventricular segments.
- Warfarin is the established standard treatment for LVT.
- Managing anticoagulation can be challenging due to international normalized ratio (INR) fluctuations.
Abstract:
Left ventricular thrombi are mostly seen in the akinetic segments of left ventricle and warfarin is the golden standard treatment. In our case, a 67-year-old male patient with ischemic dilated cardiomyopathy and atrial fibrillation was under warfarin treatment, but due to fluctuations in international normalized ratio, warfarin was discontinued and changed to rivaroxaban (20 mg once a day). He had a fixed thrombus measuring 1.80 × 1.12 cm2 in the left ventricle under warfarin treatment before rivaroxaban use. After 6 months of rivaroxaban treatment, the thrombus regressed to 1.54 × 1.06 cm2 without any embolic episode or bleeding. This case supports the finding that rivaroxaban can be a safe alternative to warfarin when warfarin cannot be used.
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