Complete resolution of huge left ventricular thrombus with apixaban treatment

A 70-year-old male patient was admitted to our Cardiology Department because of shortness of breath. An intravenous furosemide infusion showed that volume load had been decreased. A transthoracic echocardiography was performed after the patient was able to lie in the supine position. The ejection fraction was 25%, and there was moderate mitral regurgitation. The end diastolic diameter was 60 mm, and a 4 × 3 cm apical thrombus was detected. Surgical removal of the apical thrombus was not considered because of the high risk of the procedure. IV thrombolytic treatment was suggested, but the patient rejected this approach due to the risks associated with thrombolytic resolution of the thrombus. Warfarin treatment had not been started because the patient was unable to come to INR (international normalized ratio) follow-up. The patient was discharged from the hospital with a prescription, including apixaban 2 × 5 mg, metoprolol 1 × 50 mg, ramipril 1 × 2.5 mg and spironolactone/hydrocholorothiazide 1 × 25 mg. Complete disappearance of thrombus was observed on transthoracic echocardiography approximately one month later when the patient came in for polyclinic control. He had no active cardiac symptoms, and his functional capacity was I.