Does apixaban resolve left atrial appendage thrombus in a patient with heart failure and atrial fibrillation who failed warfarin therapy?
Apixaban may be an effective alternative for resolving left atrial appendage thrombus in patients with atrial fibrillation and heart failure who develop thrombi despite warfarin therapy.
The effect of non-vitamin K antagonist oral anticoagulants on left atrial appendage (LAA) thrombus has not been fully elucidated. There are a few reports showing resolution of LAA thrombus with apixaban. An 84-year-old woman was admitted to our hospital due to acute exacerbation of chronic heart failure and marked tachycardia with atrial fibrillation. She had permanent atrial fibrillation and was treated with warfarin; however, transthoracic echocardiography revealed a non-mobile thrombus in the LAA. Therefore, we switched warfarin to apixaban at a dose of 5 mg/day. After two weeks on that therapy, the thrombus in the LAA was successfully resolved.
Okada et al. (Sun,) studied this question.