Resolution of left ventricular postinfarction thrombi in patients undergoing percutaneous coronary intervention using rivaroxaban in addition to dual antiplatelet therapy

Constantinos Andreas Makrides, Constantinos Andreas Makrides

Abstract

Left ventricular (LV) thrombus is usually seen in situations with reduced LV function, and is mostly seen in patients with large anterior ST-elevation myocardial infarction (MI). Most embolic events, in patients with LV thrombus formation, occur within the first 3-4 months, thus the recommendations regarding the duration of anticoagulant therapy. According to guidelines, an oral vitamin K antagonist, warfarin, is being used as an anticoagulant for this period. Novel oral anticoagulants were found to be either non-inferior or superior compared with warfarin in prevention of thromboembolism in patients with non-valvular atrial fibrillation. However, the data about their role in the management of LV thrombus are limited to case reports. Here, we report on the dissolution of LV apical thrombus in 3 patients with anterior ST-elevation MI receiving dual antiplatelet therapy and rivaroxaban on a reduced dose for 3 months.

Conflict of interest statement

Conflicts of Interest: None declared.

2016 BMJ Publishing Group Ltd.

Figures

Figure 1
Figure 1
Contrast echocardiography study confirmed the presence of an apical sessile thrombus and a severe anteroapical hypokinesia with an EF of 35%.
Figure 2
Figure 2
Transthoracic echocardiography revealed a penduculated apical thrombus measuring 1.6×1.7 cm in an akinetic distal anteroapical area and hypokinetic anteroseptal segment with an estimated EF of 35–40%.
Figure 3
Figure 3
Transthoracic echocardiography revealed a penduculated and elongated apical thrombus measuring 2.5×1.8 cm and a severely anteroapically hypokinetic left ventricle with an EF of 30%.

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