Key result
Switching to bridged warfarin prevents recurrent embolic events after apixaban failure in LV thrombus.
Why the study?
Anticoagulation is the mainstay of therapy for left ventricular thrombus, but the optimal agent remains debated.
Does transitioning to warfarin with LMWH bridging prevent recurrent ischemic stroke in a patient with LV thrombus and severe LV dysfunction who failed apixaban therapy?
Case Report (n=1)
No
Does transitioning to warfarin with LMWH bridging prevent recurrent ischemic stroke in a patient with LV thrombus and severe LV dysfunction who failed apixaban therapy?
This case highlights that warfarin with LMWH bridging may be necessary to prevent recurrent embolic events in high-risk patients with LV thrombus and severe LV dysfunction who fail DOAC therapy.
Single case of recurrent stroke on apixaban in LV thrombus warrants caution with DOACs; leaves open optimal agent pending randomized data.
Left ventricular (LV) thrombus is a well-recognised source of cardioembolic stroke, especially in patients with severely reduced LV ejection fraction (LVEF). Anticoagulation is the mainstay of therapy, but the optimal agent remains debated. We report the case of a 68-year-old man with an LV thrombus who suffered recurrent ischemic strokes while on apixaban, with magnetic resonance imaging (MRI) of the brain demonstrating acute infarcts in the left thalamocapsular and occipitotemporal regions. Following multidisciplinary team review, he was transitioned to warfarin with low-molecular-weight heparin (LMWH) bridging, after which he achieved therapeutic international normalised ratio (INR) stability and experienced no further clinically apparent embolic events. This case underscores the ongoing embolic risk associated with LV thrombus despite direct oral anticoagulant (DOAC) therapy, the importance of LMWH bridging when initiating warfarin, and the value of multidisciplinary management in optimising outcomes.
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Riya M Jacob (2025) conducted a case report in Left ventricular thrombus and recurrent ischemic stroke (n=1). Warfarin with LMWH bridging vs. Apixaban 5 mg twice daily (prior treatment) was evaluated on Recurrent stroke. Transitioning to warfarin with low-molecular-weight heparin bridging successfully prevented further embolic events in a patient with a left ventricular thrombus who had recurrent strokes on apixaban.
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