What does this research mean for the field?

Dual antithrombotic therapy with rivaroxaban and aspirin combined with delayed surgical timing can achieve partial arterial recanalization and neurological stabilization, serving as a feasible bridging strategy to valve replacement in severe rheumatic mitral stenosis complicated by cervicocephalic thromboembolism. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To describe the multimodal management of severe rheumatic mitral stenosis complicated by left atrial appendage thrombus and extensive cervicocephalic thromboembolism.

April 27, 2026Journal of Cardiothoracic SurgeryOpen Access

Multimodal management of rheumatic mitral stenosis with widespread cervicocephalic thromboembolism

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Rheumatic mitral stenosis with widespread cervicocephalic thromboembolism (n=1). Intervention: Dual antithrombotic therapy (rivaroxaban and aspirin) followed by mitral valve replacement. Primary outcome: Neurological stabilization and vascular recanalization.

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Key result

Rivaroxaban and aspirin achieve partial recanalization to bridge a rheumatic mitral stenosis patient to valve surgery.

Population

A 36-year-old woman with rheumatic mitral stenosis complicated by left atrial thrombi and cerebellar infarction

Design

Case report

Authors

MWM H WangShandong Provincial Hospital XLXinzhi LiuShandong Provincial Hospital XZXu ZhouNuance Communications (Austria)

Discussion

Member takes

Implication

Multimodal intervention may stabilize acute embolization in rheumatic MS with LA thrombi; leaves open optimal sequencing pending dedicated trials.**[[1]](https://link.springer.com/article/10.

Key Points

To describe the multimodal management of severe rheumatic mitral stenosis complicated by left atrial appendage thrombus and extensive cervicocephalic thromboembolism.
Case report of a 36-year-old female presenting with left atrial thrombi, atrial fibrillation, brachiocephalic trunk occlusion, and cerebellar infarction.
Administered off-label dual antithrombotic therapy with rivaroxaban (10 mg daily) and aspirin (100 mg daily) due to rural residency preventing routine INR monitoring.
Delayed definitive surgery by six weeks post-cerebral infarction, performing mitral valve replacement, tricuspid annuloplasty, atrial fibrillation ablation, and left atrial appendage excision.
Dual antithrombotic therapy achieved partial vascular recanalization and neurological stabilization, with NIHSS score improving from 3 to 1 prior to surgery.
Delayed surgical intervention proceeded successfully without perioperative bleeding complications, and postoperative anticoagulation effectively prevented thromboembolic recurrence.

Study Design

Type

Case Report (n=1)

Multicenter

Structured PICO

Population

1 36-year-old Chinese Han woman with severe rheumatic mitral stenosis, moderate tricuspid regurgitation, left atrial appendage thrombus, atrial fibrillation, pulmonary hypertension, and acute cerebellar infarction due to multi-vessel cervicocephalic occlusion.

Intervention

Dual antithrombotic therapy (rivaroxaban 10 mg oral once daily and aspirin 100 mg oral once daily) for 6 weeks, followed by mitral valve replacement (25/33 mm ON-X Conform-X mechanical prosthesis), tricuspid valve annuloplasty, atrial fibrillation radiofrequency ablation, and left atrial appendage excision. Postoperative maintenance with warfarin 2.5 mg once daily.

Outcome

Vascular recanalization, neurological stabilization (NIHSS score), and prevention of recurrent embolic events or hemorrhage at 3 months postoperatively.

In a young patient with rheumatic mitral stenosis and extensive cervicocephalic thromboembolism, off-label bridging with rivaroxaban and aspirin successfully facilitated delayed surgical valve replacement.

Limitations

Off-label use of rivaroxaban in rheumatic mitral stenosis with left atrial thrombus is not guideline-supported
Single case report limits generalizability
Single case report
Off-label use of rivaroxaban in rheumatic mitral stenosis is not supported by current guidelines

Cite This Study

Wang et al. (2026) conducted a case report in Rheumatic mitral stenosis with widespread cervicocephalic thromboembolism (n=1). Dual antithrombotic therapy (rivaroxaban and aspirin) followed by mitral valve replacement was evaluated on Neurological stabilization and vascular recanalization. In a 36-year-old woman with rheumatic mitral stenosis and cervicocephalic thromboembolism, 6 weeks of dual antithrombotic therapy with rivaroxaban and aspirin led to partial recanalization and NIHSS improvement from 3 to 1, successfully bridging her to valve replacement surgery.

synapsesocial.com/papers/69eefd9bfede9185760d44c3 https://doi.org/10.1186/s13019-026-04212-8

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Implication

Multimodal intervention may stabilize acute embolization in rheumatic MS with LA thrombi; leaves open optimal sequencing pending dedicated trials.**[[1]](https://link.springer.com/article/10.

Multimodal management of rheumatic mitral stenosis with widespread cervicocephalic thromboembolism

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Limitations

Cite This Study

Multimodal management of rheumatic mitral stenosis with widespread cervicocephalic thromboembolism

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Limitations

Cite This Study

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