Key result
Dabigatran therapy successfully resolved pre-existing left atrial appendage thrombi that were resistant to rivaroxaban in two patients with persistent atrial fibrillation.
Why the study?
Does dabigatran resolve rivaroxaban-resistant left atrial appendage thrombi in patients with persistent atrial fibrillation?
Case Report (n=2)
No
Does dabigatran resolve rivaroxaban-resistant left atrial appendage thrombi in patients with persistent atrial fibrillation?
Switching from a factor Xa inhibitor (rivaroxaban) to a direct thrombin inhibitor (dabigatran) may be an effective strategy for resolving DOAC-resistant left atrial appendage thrombi in patients with persistent atrial fibrillation.
Answers are grounded in this paper and cite their sources.
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Requires caution assuming thrombus resolution with long-term DOACs in large-LA AF; leaves open need for TEE monitoring.
Patients with persistent atrial fibrillation (AF) and a large left atrium are at a high risk for thromboembolisms. Recently, direct oral anticoagulants (DOACs) have mainly been used for the prevention of cardiac embolisms caused by AF. Transesophageal echocardiography (TEE) is performed in order to exclude any left atrial appendage (LAA) thrombi. We herein report two cases of persistent AF, both of which were treated with rivaroxaban for more than two years. Since TEE identified mobile LAA thrombi with this treatment, we switched from rivaroxaban to the direct thrombin inhibitor dabigatran. Dabigatran resolved the LAA thrombi that had been refractory to rivaroxaban.
Watanabe et al. (2017) conducted a case report in Persistent atrial fibrillation with rivaroxaban-resistant left atrial appendage thrombi (n=2). Dabigatran vs. Rivaroxaban (prior therapy) was evaluated on Resolution of left atrial appendage thrombus. Dabigatran therapy successfully resolved pre-existing left atrial appendage thrombi that were resistant to rivaroxaban in two patients with persistent atrial fibrillation.
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