Key result
A left atrial appendage thrombus that developed during dabigatran 110 mg BID therapy in a 77-year-old man with nonvalvular atrial fibrillation completely resolved 13 days after switching to rivaroxaban 15 mg QD.
Why the study?
Does switching to rivaroxaban 15 mg once daily resolve a left atrial appendage thrombus that developed during dabigatran 110 mg twice daily therapy in a patient with non-valvular atrial fibrillation?
Case Report (n=1)
No
Does switching to rivaroxaban 15 mg once daily resolve a left atrial appendage thrombus that developed during dabigatran 110 mg twice daily therapy in a patient with non-valvular atrial fibrillation?
Switching from dabigatran to rivaroxaban successfully resolved a left atrial appendage thrombus in a patient with non-valvular atrial fibrillation.
Does not support NOAC switching for LAA thrombus; leaves open differential efficacy requiring prospective trials.
要旨：症例は77 歳男性．非弁膜症性心房細動に対しdabigatran 110 mg 1 日2 回内服中．2014 年10月某日に一過性の言語障害を主訴に来院，一過性脳虚血発作の診断で入院した．第2 病日に施行した経食道心エコーで左心耳に心内血栓を認め抗凝固薬をrivaroxaban 15 mg 1 日1 回に変更，血栓は縮小し第13 病日に消失した．凝固系を抑え抗凝固療法に伴う心内血栓縮小現象を惹起する点ではdabigatran 110 mg 1 日2 回よりもrivaroxaban 15 mg 1 日1 回の方がより効果的である可能性がある．抗トロンビン薬と抗Xa 薬の作用機序の差異への考察と心内血栓と非ビタミンK 拮抗経口抗凝固薬に関する文献的考察を踏まえて報告する．
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Wada et al. (2015) conducted a case report in Nonvalvular atrial fibrillation with left atrial appendage thrombus (n=1). Rivaroxaban vs. Dabigatran 110 mg BID (prior therapy) was evaluated on Resolution of left atrial appendage thrombus. A left atrial appendage thrombus that developed during dabigatran 110 mg BID therapy in a 77-year-old man with nonvalvular atrial fibrillation completely resolved 13 days after switching to rivaroxaban 15 mg QD.
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