Resolution of left atrial appendage thrombus with apixaban

Tohru Kawakami, Hiroko Kobayakawa, Hiroyoshi Ohno, Nobukiyo Tanaka, Hiroki Ishihara, Tohru Kawakami, Hiroko Kobayakawa, Hiroyoshi Ohno, Nobukiyo Tanaka, Hiroki Ishihara

Abstract

Left atrial appendage (LAA) thrombosis is an important cause of cardiogenic cerebral thromboembolism. Apixaban is a member of the class of novel oral anticoagulants (NOAC) and is superior to warfarin in preventing stroke or systemic embolism, causes less bleeding, and results in lower mortality in patients with atrial fibrillation. There are few reports of resolution of LAA thrombus with other NOAC. We present a 72-year-old male patient with persistent atrial fibrillation associated with left atrial thrombus. Sixteen days of apixaban treatment showed complete thrombus resolution. In this study, soluble fibrin and D-dimer levels decreased without prolongation of international normalized ratio (INR) and activated partial thromboplastin time (APTT).

Figures

Figure 1
Figure 1
Transesophageal echocardiography and laboratory data for the coagulation system. A) Small thrombus formation (arrow) in the apex of the left atrial appendage (LAA) on day 4. B) Thrombus resolution after 16 days of anticoagulant therapy with apixaban. C) Plot of laboratory data for the coagulation system demonstrates a fall in SF, a rise and subsequent fall in D-dimer (DD), without prolongation of INR or APTT.

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