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Mechanical Aortic Valve Thrombosis During Anticoagulation Using Oral Rivaroxaban: A Case Report
Ryoji Kinoshita1, Taiju Watanabe1, Ryumon Matsumoto1
1Cardiovascular Surgery, Tsuchiura Kyodo General Hospital, Tsuchiura, JPN.
Cureus
|July 24, 2024
Summary
Direct oral anticoagulants (DOACs) are contraindicated in patients with mechanical heart valves. A case report shows rivaroxaban use in a mechanical aortic valve patient led to a life-threatening thrombus, necessitating valve replacement.
Area of Science:
- Cardiovascular Medicine
- Pharmacology
- Medical Case Reports
Background:
- Direct oral anticoagulants (DOACs) are increasingly utilized in cardiovascular disease management.
- Established guidelines contraindicate DOACs, including rivaroxaban, for patients with mechanical heart valves.
- Warfarin is the standard anticoagulation therapy for individuals with mechanical heart valves.
Observation:
- A 65-year-old male with a mechanical aortic valve transitioned from warfarin to rivaroxaban.
- Six months post-transition, the patient presented with syncope and chest discomfort.
- Echocardiography confirmed a thrombus formation on the mechanical aortic valve.
Findings:
- Rivaroxaban use in a patient with a mechanical aortic valve was associated with thrombus formation.
- The patient required urgent reoperation due to the mechanical valve thrombus.
- Successful replacement with a bioprosthetic valve was performed, with an uneventful recovery.
Implications:
- This case underscores the critical risks of using rivaroxaban in patients with mechanical aortic valves.
- It highlights the necessity of adhering to warfarin anticoagulation protocols for this high-risk population.
- DOACs lack proven efficacy and safety in patients with mechanical heart valves, reinforcing contraindications.
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