Apixaban in left ventricular thrombi treatment - a report of seven cases

Treatment of intracardiac thrombi (ICTs) with direct-acting oral anticoagulants (DOACs) constitutes a new challenge for this group of medications. Left ventricular thrombi (LVTs) occur mainly in patients with severe left ventricular dysfunction. Advanced heart failure is characterized by a high prevalence of chronic kidney disease (CKD). Apixaban has the best renal profile among all DOACs. The authors describe a group of 7 patients with LVTs treated with apixaban; 6 of them had CKD. LVTs were screened and monitored during therapy using a sector, 3-dimensional and high frequency linear probes; the latter to exclusively assess the left ventricular apex. Examination was performed every day during the first 2 weeks, then 2-3 times a week until LVTs disappearance, then every month; transesophageal assessment was done initially and repeated when necessary. Patients' mean age was 65 years. The underlying disease was post-myocardial left ventricular dysfunction (3), dilated cardiomyopathy (3) and heart failure of unknown etiology (1).Three patients had more than one LVT. Also, three had other ICTs, one - in the right ventricle, two - in the left atrial appendage. Three patients used apixaban in a dose of 5 mg twice daily, two - 2.5 mg twice a day, two - in an increasing dose. In all patients, gradual diminishing of LVTs was observed, no complications of apixaban therapy were noted. The time needed for LVTs disappearance was between 7 and 28 days (mean: 17 days).