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Successful Resolution of a Large Left Atrial and Left Atrial Appendage Thrombus with Rivaroxaban

Safwan Gaznabi1, Ashraf Abugroun1, Hasan Mahbub2

  • 1Department of Internal Medicine, Advocate Illinois Masonic Medical Center, 836 W Wellington Ave., Chicago, IL 60657, USA.

Case Reports in Cardiology
|May 17, 2019
PubMed

Insights

Rivaroxaban effectively resolved a large left atrial appendage thrombus in a heart failure patient with atrial fibrillation. Further studies are needed to confirm direct oral anticoagulants

Area of Science:

  • Cardiology
  • Pharmacology

Background:

  • Atrial fibrillation frequently leads to intracardiac thrombus formation, posing a risk for thromboembolic events.
  • Transesophageal echocardiography (TEE) is crucial for diagnosing left atrial appendage thrombi.
  • Warfarin has been the standard anticoagulant, but direct oral anticoagulants (DOACs) are increasingly used.

Observation:

  • A 79-year-old male with heart failure and atrial fibrillation presented with a large, mobile left atrial appendage thrombus.
  • The patient opted for rivaroxaban over warfarin for anticoagulation therapy.
  • Repeat TEE after 3 months of rivaroxaban showed complete resolution of the thrombus.

Findings:

  • Rivaroxaban demonstrated efficacy in resolving a significant left atrial appendage thrombus.
  • This case suggests potential for DOACs in treating intracardiac thrombi, though data is limited.
  • Successful thrombus lysis with rivaroxaban was confirmed by TEE.

Implications:

  • This case supports the investigation of DOACs for intracardiac thrombus treatment.
  • DOACs may offer improved patient compliance, reduced hospital stays, and enhanced treatment efficacy compared to warfarin.
  • Further clinical trials are warranted to establish the role and effectiveness of DOACs in managing intracardiac thrombi.

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