This case report highlights the severe risk of fatal mechanical valve thrombosis when using target-specific oral anticoagulants like rivaroxaban instead of standard therapy.
Highlights the catastrophic risk of off-label DOAC use in mechanical valves;.
This is a case of a 54-year-old female with a history of mechanical aortic valve replacement who presented in cardiogenic shock. Her primary care provider started her on rivaroxaban for anticoagulation therapy. An urgent transesophageal echocardiogram revealed a significant gradient and thrombosis on one leaflet of the valve that was immobile. Given that she was not a surgical candidate, she underwent thrombolysis. However, she later died due to complications from the thrombotic valve. The utility of target-specific oral anticoagulants has yet to be established in clinical practice.
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Kumar et al. (2017) studied this question.
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