Key result
Rivaroxaban reverses bioprosthetic aortic valve thrombosis in one patient, reducing Vmax by ~27%.
Why the study?
There are limited data comparing the efficacy of warfarin and novel oral anticoagulant therapy for subacute bioprosthetic valve thrombosis.
Does rivaroxaban improve subacute bioprosthetic aortic valve thrombosis in a patient with limited response to warfarin?
Case Report (n=1)
Does rivaroxaban improve subacute bioprosthetic aortic valve thrombosis in a patient with limited response to warfarin?
Rivaroxaban successfully reversed subacute bioprosthetic aortic valve thrombosis in a patient who had previously failed 6 months of warfarin therapy.
Answers are grounded in this paper and cite their sources.
May support rivaroxaban for bioprosthetic valve thrombosis; hypothesis-generating case report requiring prospective trials before practice change.
Background: Bioprosthetic valve thrombosis (BPVT) is a rare but recognised complication causing valve dysfunction. In subacute valve thrombosis, systemic oral anticoagulation is recommended. However, there is little data comparing the efficacy of warfarin and novel oral anticoagulant (NOAC) therapy in this setting. Case Summary: A patient developed subacute BPVT 11 years post-implantation. The patient was initially treated with warfarin for a period of 6 months, with limited effect. Following replacement of warfarin with rivaroxaban, there was significant reversal of the BPVT, as represented by a reduction in transaortic maximal velocity (Vmax) from 4.1m/s to 3m/s over 7 months. Discussion: Systemic oral anticoagulation can be an effective treatment for subacute valve thrombosis. Guidelines currently recommend warfarin as first line but NOACs can be considered in such patients and may be more effective than warfarin. Randomised controlled trials are required to further establish the optimal anticoagulation for patients with subacute BPVT.
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Sharma et al. (2020) conducted a case report in Bioprosthetic valve thrombosis (n=1). Rivaroxaban vs. Warfarin was evaluated on Transaortic maximal velocity (Vmax). In a patient with subacute bioprosthetic aortic valve thrombosis, treatment with rivaroxaban reduced transaortic maximal velocity from 4.1 to 3.0 m/s over 7 months, indicating thrombosis reversal.
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