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Updated: Sep 18, 2025

The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
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Discordant Antithrombotic Effects of Apixaban in Fibrillating Left Atria vs Post-Myocardial Infarction Left

Yusuke Yamazaki1, Toru Egashira1, Mayu Nozawa1

  • 1Department of Cardiology, Tachikawa Hospital, Tokyo, Japan.

JACC. Case Reports
|June 20, 2025
PubMed

Insights

Optimal anticoagulation for left ventricular thrombus (LVT) after acute myocardial infarction (AMI) is debated. A case revealed apixaban

Area of Science:

  • Cardiology
  • Thrombosis Research
  • Pharmacology

Background:

  • Left ventricular thrombus (LVT) frequently complicates acute myocardial infarction (AMI).
  • Optimal anticoagulant therapy for LVT remains a significant clinical question.

Observation:

  • A patient with atrial fibrillation developed simultaneous LVT and left atrial appendage thrombus (LAAT) post-AMI.
  • Warfarin optimization initially resolved both thrombi.
  • Apixaban suppressed LAAT but LVT recurred, resolving upon warfarin resumption.

Findings:

  • Apixaban demonstrated discordant antithrombotic effects on LVT and LAAT in this case.
  • This suggests potential differences in the characteristics of simultaneous thrombi.
  • Warfarin was effective in resolving recurrent LVT where apixaban failed.

Implications:

  • A personalized approach to anticoagulation for LVT may be necessary.
  • Therapeutic strategies should consider individual thrombus efficacy.
  • Current one-size-fits-all treatment paradigms for LVT may require reevaluation.
Abstract

Keywords:
acute myocardial infarctiondirect oral anticoagulantleft atrial appendage thrombusleft ventricular thrombusvitamin K antagonist

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