Large Left Ventricular Thrombus as a Cause of Recurrent Cardioembolic Stroke While on Dabigatran

Abstract

Graphical abstract

An Updated Review of the Efficacy and Safety of Direct Oral Anticoagulants in Treatment of Left Ventricular Thrombus

“…Dabigatran in the literature is limited, but there are 3 instances in which dabigatran has led to LV thrombus resolution in the postmyocardial infarction period specifically; these are reflected in Table 3. [15][16][17] Dabigatran, overall, has resulted in less robust outcomes: cases such as the ones in Table 4 11,18 have documented both thromboembolic stroke and sustained persistence of large thrombus over 2000+ days while on this therapy. There are also instances of patients, such as in Table 5, 19 on dabigatran for anticoagulation for an alternative pathology, that have developed LV apical thrombus after starting the dabigatran therapy.…”

“…[7][8][9] Contrarily, some studies have shown catastrophic, recurrent cardioembolic strokes in young patients while continuing DOAC therapy for LV thrombus or simply shown scenarios where DOACs fall short of warfarin's historical gold standard. 10,11…”

Successful thrombolysis for acute ischaemic stroke after reversal of dabigatran etexilate with idarucizumab

“…Conventional clinical guidelines suggest vitamin K antagonist (VKA) for treatment of LV thrombus 13. However, dabigatran has been reported to be effective in the treatment of LV thrombus with complete resolution of thrombus in some cases 14–17. Dabigatran may be an alternative method of anticoagulation for LV thrombus given its stable pharmacokinetic profile and the availability of rapid reversal with idarucizumab in the event of severe bleeding.…”

Left Ventricular Thrombosis: Current Perspective and Use of Direct Oral Anticoagulants

“…[57] и B. Kaku и соавт. [58] продемонстрировали резолюцию тромба у больных с гипертрофической кардиомиопатией при применении апиксабана и дабигатрана соответственно. Elikowski W. и соавт.…”