Why the study?
Does rivaroxaban resolve left ventricular thrombus in a patient with tachycardia-induced heart failure?
Does rivaroxaban resolve left ventricular thrombus in a patient with tachycardia-induced heart failure?
Rivaroxaban may have fibrinolytic effects leading to the rapid resolution of left ventricular thrombus in patients with tachycardia-induced heart failure.
Rapid LV thrombus resolution with rivaroxaban in one tachycardia-induced HF case is hypothesis-generating; controlled trials needed before practice change.
A 42-year-old man was admitted to our hospital because of lumbago and tachycardia-induced heart failure. Transthoracic echocardiography revealed impaired left ventricular function and a ball mass of thrombus in the left ventricle (LV). He was found to have systemic embolism in the spleen, kidneys, brain, and limbs. The patient was treated with limb thrombectomy followed by anticoagulation. Seven days after the direct factor Xa inhibitor, rivaroxaban, was initiated, transthoracic echocardiography was repeated, revealing disappearance of the LV thrombus without any clinical signs of cardiogenic embolism. His heart failure responded well and the LV wall motion had improved. This case suggests rivaroxaban has fibrinolytic effects on thrombi even in the LV.
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Nakasuka et al. (2014) studied this question.
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