Key result
Apixaban therapy failed to prevent left ventricular thrombus progression in a patient with severe ischaemic cardiomyopathy, whereas subsequent warfarin therapy led to thrombus resolution at 6 months.
Why the study?
Does apixaban prevent left ventricular thrombus recurrence in a patient with severe ischaemic cardiomyopathy?
Case Report (n=1)
Does apixaban prevent left ventricular thrombus recurrence in a patient with severe ischaemic cardiomyopathy?
This case highlights a potential failure of apixaban in preventing LV thrombus recurrence, which subsequently resolved with standard warfarin therapy.
Apixaban may fail to prevent LV thrombus recurrence in severe ischaemic cardiomyopathy; leaves open comparative efficacy versus warfarin.
Background. Anticoagulation with warfarin remains the mainstay treatment for left ventricular thrombi. Although successful thrombus resolution has been reported with direct oral anticoagulants’ (DOACs’) recurrence/progression while resuming Apixaban therapy is yet to be reported. Case Presentation. This case report describes left ventricular thrombus progression/recurrence in a patient anticoagulated with Apixaban undergoing implantable cardioverter defibrillator to cardiac resynchronisation therapy with defibrillator upgrade procedure. He was thereafter changed to warfarin. Contrast echocardiogram at 6 months follow-up did not identify the previously demonstrated mural thrombus. Conclusion. Prospective randomised control trials should be conducted in patients with left ventricular thrombus to compare anticoagulants, assess the efficacy and safety of DOACs, and evaluate uninterrupted DOAC versus transient withdrawal for cardiac device procedures.
No takes yet. Share an insight, caveat, or question.
Farooqui et al. (2022) conducted a case report in Severe ischaemic cardiomyopathy with left ventricular thrombus (n=1). Apixaban vs. Warfarin was evaluated on Left ventricular thrombus progression/recurrence. Apixaban therapy failed to prevent left ventricular thrombus progression in a patient with severe ischaemic cardiomyopathy, whereas subsequent warfarin therapy led to thrombus resolution at 6 months.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: