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

Gaznabi, Safwan; Abugroun, Ashraf; Hasan, Mahmudul; Campos, Enrique Padilla

doi:10.1155/2019/6076923

Cited by 3 publications

(4 citation statements)

References 18 publications

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“…However, the time to resolution was shorter in patients who had rivaroxaban. Data on direct oral anticoagulants, specifically in patients with intra-cardiac thrombus, are limited [11]. In a randomized trial, rivaroxaban was more effective than warfarin in the resolution of left atrial thrombus in patients with non-valvular atrial fibrillation [12].…”

Section: Discussionmentioning

confidence: 99%

Rivaroxaban versus warfarin for the management of left ventricle thrombus

et al. 2021

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Background Rivaroxaban has been recently introduced for the management of non-valvular intra-cardiac thrombosis with variable results. We aimed to compare the results of the off-label use of rivaroxaban versus warfarin in the management of patients with left ventricle (LV) thrombus. This research is a retrospective study conducted on 63 patients who had LV thrombus from January to December 2016. We compared patients treated with warfarin (n=35) to patients who had rivaroxaban (n=28), and study outcomes were time to thrombus resolution, bleeding, stroke, and mortality. Results The median duration of treatment was 9.5 (25th-75th percentiles: 6-32.5) months for rivaroxaban and 14 (3-41) months for warfarin. Thrombus resolution occurred in 24 patients in the warfarin group (68.6%) and 20 patients in the rivaroxaban group (71.4%). The median time to resolution in the warfarin group was 9 (4-20) months and 3 (2-11.5) months in the rivaroxaban group. Thrombus resolution was significantly faster in patients on rivaroxaban (p= 0.019). Predictors of thrombus resolution were thrombus surface area (HR: 1.21; CI 95% (1.0-1.46); p= .048) and the use of rivaroxaban (HR: 1.92; CI 95% (1.01-3.65); p= 0.048). There was no difference in stroke, bleeding, and mortality between both groups. Conclusion Rivaroxaban was as effective and safe as warfarin in managing patients with left ventricle thrombus. Larger randomized clinical trials are recommended to confirm our findings.

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Section: Discussionmentioning

confidence: 99%

Rivaroxaban versus warfarin for the management of left ventricle thrombus

et al. 2021

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“…The same hemodynamic condition that predisposes to the formation of thrombi in the LV is also found in the left atrial appendage. Starting from this similarity, from the favorable outcomes in patients with AF [ 119 ], and from the evidence that DOACs lead to the dissolution of atrial thrombi [ 2 , 3 , 4 ], the premises for the use of DOACs in patients with LV thrombus were outlined.…”

Section: Discussionmentioning

confidence: 99%

“…Left atrial (LA) or left atrial appendage (LAA) thrombi are identified in up to 10% of patients with AF and current guidelines recommend anticoagulant therapy for at least three weeks upon their detection [ 1 ]. Resolution of LA/LAA thrombus in patients receiving a DOAC has already been reported, even in cases with large thrombi [ 2 , 3 , 4 ]. Moreover, the X-TRA study—a comparative study between rivaroxaban and VKA—showed that rivaroxaban can be a potential option for the treatment of thrombi identified in LA/LAA in patients with AF [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Direct Oral Anticoagulants for Stroke and Systemic Embolism Prevention in Patients with Left Ventricular Thrombus

Bădescu

Șorodoc

Lionte

et al. 2023

JPM

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In recent years, direct oral anticoagulants (DOAC) have accumulated evidence of efficacy and safety in various clinical scenarios and are approved for a wide spectrum of indications. Still, they are currently used off-label for left ventricular thrombus owing to a paucity of evidence. For the same reason, there is a lack of guideline indication as well. Our work is based on an exhaustive analysis of the available literature and provides a structured and detailed update on the use of DOACs in patients with left ventricle thrombus. The safety and efficacy of DOACs were analyzed in particular clinical scenarios. As far as we know, this is the first paper that analyzes DOACs in this approach.

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“…ASS (5 mg/kg, PO, SID) was used in the two dogs of the study of Hildebrandt et al [ 11 ]. Likewise, a left atrial thrombus in men was cured by administering rivaroxaban [ 36 ]. Thrombi in the left ventricle and left auricle in an American Cocker Spaniel were shown by echocardiography.…”

Section: Discussionmentioning

confidence: 99%

The Rare Occurrence of a Left Atrial Thrombus in a Dog

Otto¹,

Hopfner²

2020

Case Reports in Veterinary Medicine

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Intracardiac thrombi are rare in dogs. If they occur, they are mostly seen in the right atrium while only two case reports describing a mural left atrial thrombus in dogs are available. This case report describes a 14-year-old mixed-breed bitch that was presented at the clinic because of dyspnoea. The dog suffered from alopecia for about three years and displayed polyuria and polydipsia for a number of months. Clinical examination revealed intensified inspiratory and expiratory respiratory sounds and various heart sounds. Chest X-ray showed cardiomegaly (VHS 11) and a mixed bronchoalveolar lung pattern of the caudal lung. A transthoracic echocardiography was performed and showed a moderate mitral regurgitation, a highly dilated left atrium, a low-grade pulmonary insufficiency, and a minimal aortic and tricuspid insufficiency. Additionally, a free-floating ball thrombus was found in the left atrium. Hyperadrenocorticism was indicated by an ACTH stimulation test. The previous medical therapy of the referring veterinarian consisted of benazepril and furosemide and was complemented by clopidogrel. The pet owners declined any further clinical diagnostics and therapy. The dog died 19 days later. This is the first reported case of a dog with a free-floating left atrial thrombus. Specific therapeutic strategies for intracardiac thrombi in the dog are currently not available, and therefore, every patient should be treated individually.

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

Cited by 3 publications

References 18 publications

Rivaroxaban versus warfarin for the management of left ventricle thrombus

Rivaroxaban versus warfarin for the management of left ventricle thrombus

Direct Oral Anticoagulants for Stroke and Systemic Embolism Prevention in Patients with Left Ventricular Thrombus

The Rare Occurrence of a Left Atrial Thrombus in a Dog

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