Key result
Rivaroxaban treatment for 6 months partially resolved and changed the quality of thrombi in the left atrium and right lower pulmonary vein, which was detectable by transoesophageal echocardiography but not by 80-MDCT.
Why the study?
Does rivaroxaban reduce thrombus size in the left atrium and pulmonary vein in an elderly patient?
Case Report (n=1)
No
Does rivaroxaban reduce thrombus size in the left atrium and pulmonary vein in an elderly patient?
Rivaroxaban may reduce the size and change the quality of left atrial and pulmonary vein thrombi, which can be effectively monitored by TEE even when missed by 80-MDCT.
Rivaroxaban may reduce left atrial and pulmonary vein thrombi in select elderly patients; hypothesis-generating and should not yet change practice.
Stroke is a clinically important problem. A left atrial thrombus is known as a cause of ischaemic stroke. A pulmonary vein thrombus (PVT) is thought to be rare; however, PVT is common in elderly patients. Additionally, images of PVT with transoesophageal echocardiography (TEE) following treatment have not been well contrasted with that from either 64 or 80-slice multidetector CT (80-MDCT). The images of such changes depicted by TEE remain unknown. An 87-year-old man with hypertension was examined by 80-MDCT and TEE to check the cardiac thrombus. Although 80-MDCT did not depict the thrombus, TEE depicted the thrombus in the left atrium and right lower pulmonary vein (RLPV) clearly. After 6 months of rivaroxaban treatment, the thrombus in the RLPV decreased slightly and the thrombus in the left atrium became small and lucent, as estimated with TEE. Rivaroxaban decreased the size of the thrombus and changed the quality of the thrombus.
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Hidekazu Takeuchi (2017) conducted a case report in Left atrial and pulmonary vein thrombus (n=1). Rivaroxaban was evaluated on Thrombus resolution assessed by transoesophageal echocardiography and 80-MDCT. Rivaroxaban treatment for 6 months partially resolved and changed the quality of thrombi in the left atrium and right lower pulmonary vein, which was detectable by transoesophageal echocardiography but not by 80-MDCT.
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