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Case Reports
. 2019 Apr 9:2019:6076923.
doi: 10.1155/2019/6076923. eCollection 2019.

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

Safwan Gaznabi  1 , Ashraf Abugroun  1 , Hasan Mahbub  2 , Enrique Campos  3
Affiliations
Case Reports

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

Safwan Gaznabi et al. Case Rep Cardiol. .

Abstract

A 79-year-old male was admitted to the hospital for acute exacerbation of heart failure. The patient had history of atrial fibrillation and was planned for cardioversion. Preprocedure transesophageal echocardiogram (TEE) revealed a large multilobulated mobile thrombus in the left atrial appendage. The patient refused warfarin therapy and instead chose to take rivaroxaban. Upon outpatient follow-up, 3 months later, no visible thrombus was appreciated on repeat TEE. This case demonstrates successful resolution of left atrial and left atrial appendage thrombi with the use of rivaroxaban. At present time, limited data is available to support the use of rivaroxaban for treatment of intracardiac thrombi. This case highlights the need for further studies to investigate the outcomes and relative efficiency of use of direct oral anticoagulants (DOACs) in lysis of intracardiac thrombus. The benefits of DOACs compared to the standard of therapy could increase patient compliance, reduce length of stay, and improve treatment efficacy.

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Figures

Figure 1
Figure 1
EKG shows atrial fibrillation and LBBB.
Figure 2
Figure 2
(a) CXR showed cardiomegaly with pulmonary congestion and bilateral pleural effusion. (b) CT chest with contrast showed moderately large bilateral pleural effusions, right greater than left, with cardiomegaly and reflux of IV contrast into the IVC, consistent with cardiogenic pulmonary vascular congestion.
Figure 3
Figure 3
(a) The TEE transesophageal short axis view shows a large multilobulated mobile thrombus in the left atrial appendage. (b) TEE done 3 months later shows resolution of the thrombus.
See this image and copyright information in PMC

References

    1. Chugh S. S., Havmoeller R., Narayanan K., et al. Worldwide epidemiology of atrial fibrillation: a Global Burden of Disease 2010 Study. Circulation. 2014;129(8):837–847. doi: 10.1161/CIRCULATIONAHA.113.005119. - DOI - PMC - PubMed
    1. Brickner M. E., Friedman D. B., Cigarroa C. G., Grayburn P. A. Relation of thrombus in the left atrial appendage by transesophageal echocardiography to clinical risk factors for thrombus formation. The American Journal of Cardiology. 1994;74(4):391–393. doi: 10.1016/0002-9149(94)90409-X. - DOI - PubMed
    1. Kamp O. Importance of left atrial appendage flow as a predictor of thromboembolic events in patients with atrial fibrillation. European Heart Journal. 1999;20(13):979–985. doi: 10.1053/euhj.1998.1453. - DOI - PubMed
    1. Ruff C. T., Giugliano R. P., Braunwald E., et al. Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a metaanalysis of randomised trials. The Lancet. 2014;383(9921):955–962. doi: 10.1016/S0140-6736(13)62343-0. - DOI - PubMed
    1. Salazar C. A., Aguila D. D., Cordova E. G. Direct thrombin inhibitors versus vitamin K antagonists for preventing cerebral or systemic embolism in patients with non-valvular atrial fibrillation. Cochrane Database of Systematic Reviews. 2014;(3) doi: 10.1002/14651858.CD009893.pub2. - DOI - PMC - PubMed

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