Two-week administration of rivaroxaban resolved left atrial thrombus

Abstract

An 89-year-old man visited our hospital complaining of palpitation. Electrocardiography showed atrial fibrillation, and transthoracic echocardiography demonstrated a mobile thrombus of 28.6 mm × 20.8 mm in the left atrium. Administration of a direct factor Xa inhibitor rivaroxaban (10 mg/day) was started. The thrombus reduced its size and disappeared completely 2 weeks after the commencement of rivaroxaban treatment. To our knowledge, this is the first case report that rivaroxaban successfully dissolved left atrial thrombus during a short period. Rivaroxaban might have a potential, not only to prevent de novo thrombus formation, but also to dissolve established thrombi by direct inhibition of free and thrombus-associated factor Xa. <Learning objective: The incidence of nonvalvular atrial fibrillation is increasing, and left atrial thrombus is the major cause of cardiogenic thrombo-embolism that we need to prevent. Recently, novel oral anticoagulants have been developed. The effects of these agents on intracardiac thrombus resolution have not been fully elucidated. Data from a large cohort study would be required to assess efficacy of novel oral anticoagulants for thrombus resolution.>.

Keywords: Anticoagulation; Atrial fibrillation; Intracardiac thrombus; Nonvalvular atrial fibrillation; Rivaroxaban.

Fig. 1

Transthoracic echocardiography at visit demonstrated a mobile thrombus of 28.6 mm × 20.8 mm (arrows) in the left atrium. LA, left atrium; LV, left ventricle.

Fig. 2

After 5 days of rivaroxaban 10 mg/day treatment, transthoracic echocardiography showed that the thrombus shrunk to 20.3 mm × 15.6 mm (arrows). LA, left atrium; LV, left ventricle.

Fig. 3

After 14 days of treatment with rivaroxaban 10 mg/day, the thrombus disappeared completely on transesophageal echocardiography.