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Case Reports
. 2022 Jul 21:2022:8156942.
doi: 10.1155/2022/8156942. eCollection 2022.

Recurrence of LV Thrombus in a Patient with Severe Ischaemic Cardiomyopathy Anticoagulated with Apixaban

Azhar Farooqui  1   2 , Tin Lwin  1   3 , Daniel Costa  1 , Simon Hetherington  1   4 , Raj Mattu  1   5
Affiliations
Case Reports

Recurrence of LV Thrombus in a Patient with Severe Ischaemic Cardiomyopathy Anticoagulated with Apixaban

Azhar Farooqui et al. Case Rep Cardiol. .

Abstract

Background: Anticoagulation with warfarin remains the mainstay treatment for left ventricular thrombi. Although successful thrombus resolution has been reported with direct oral anticoagulants' (DOACs') recurrence/progression while resuming Apixaban therapy is yet to be reported. Case Presentation. This case report describes left ventricular thrombus progression/recurrence in a patient anticoagulated with Apixaban undergoing implantable cardioverter defibrillator to cardiac resynchronisation therapy with defibrillator upgrade procedure. He was thereafter changed to warfarin. Contrast echocardiogram at 6 months follow-up did not identify the previously demonstrated mural thrombus.

Conclusion: Prospective randomised control trials should be conducted in patients with left ventricular thrombus to compare anticoagulants, assess the efficacy and safety of DOACs, and evaluate uninterrupted DOAC versus transient withdrawal for cardiac device procedures.

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Conflict of interest statement

All authors declare that they have no conflicts of interest.

Figures

Figure 1
Figure 1
Delayed enhanced cardiac magnetic resonance image. Delayed enhanced cardiac MR (CMR) demonstrating an apical laminar thrombus (blocked arrow).
Figure 2
Figure 2
Post device upgrade ECHO. (a) Parasternal short axis view and (b) apical 4-chamber view of transthoracic echocardiogram demonstrating the left ventricular apical thrombus (arrow).
Figure 3
Figure 3
Contrast-enhanced transthoracic echocardiogram. Contrast ECHO demonstrating the left ventricular thrombus.
See this image and copyright information in PMC

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