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Published in: Thrombosis Journal 1/2013

Open Access 01-12-2013 | Case report

Resolution of left atrial appendage thrombus with apixaban

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

Published in: Thrombosis Journal | Issue 1/2013

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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).
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Literature
1.
go back to reference The European Atrial Fibrillation Trial Study Group: Optimal oral anticoagulant therapy in patients with nonrheumatic atrial fibrillation and recent cerebral ischemia. N Engl J Med 1995, 333: 5-10.CrossRef The European Atrial Fibrillation Trial Study Group: Optimal oral anticoagulant therapy in patients with nonrheumatic atrial fibrillation and recent cerebral ischemia. N Engl J Med 1995, 333: 5-10.CrossRef
2.
go back to reference Granger CB, Alexander JH, McMurray JJ, Lopes RD, Hylek EM, Hanna M, Al-Khalidi HR, Ansell J, Atar D, Avezum A, Bahit MC, Diaz R, Easton JD, Ezekowitz JA, Flaker G, Garcia D, Geraldes M, Gersh BJ, Golitsyn S, Goto S, Hermosillo AG, Hohnloser SH, Horowitz J, Mohan P, Jansky P, Lewis BS, Lopez-Sendon JL, Pais P, Parkhomenko A, Verheugt FW, et al.: Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med 2011, 365: 981-992. 10.1056/NEJMoa1107039CrossRefPubMed Granger CB, Alexander JH, McMurray JJ, Lopes RD, Hylek EM, Hanna M, Al-Khalidi HR, Ansell J, Atar D, Avezum A, Bahit MC, Diaz R, Easton JD, Ezekowitz JA, Flaker G, Garcia D, Geraldes M, Gersh BJ, Golitsyn S, Goto S, Hermosillo AG, Hohnloser SH, Horowitz J, Mohan P, Jansky P, Lewis BS, Lopez-Sendon JL, Pais P, Parkhomenko A, Verheugt FW, et al.: Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med 2011, 365: 981-992. 10.1056/NEJMoa1107039CrossRefPubMed
3.
go back to reference Vidal A, Vanerio G: Dabigatran and left atrial appendage thrombus. J Thromb Thrombolysis 2012, 34: 545-547. 10.1007/s11239-012-0747-1CrossRefPubMed Vidal A, Vanerio G: Dabigatran and left atrial appendage thrombus. J Thromb Thrombolysis 2012, 34: 545-547. 10.1007/s11239-012-0747-1CrossRefPubMed
4.
go back to reference Hammerstingl C, Potzsch B, Nickenig G: Resolution of giant left atrial appendage thrombus with rivaroxaban. Thromb Haemost 2013, 109: 583-584. 10.1160/TH12-11-0821CrossRefPubMed Hammerstingl C, Potzsch B, Nickenig G: Resolution of giant left atrial appendage thrombus with rivaroxaban. Thromb Haemost 2013, 109: 583-584. 10.1160/TH12-11-0821CrossRefPubMed
5.
go back to reference Kimura M, Wasaki Y, Ogawa H, Nakatsuka M, Wakeyama T, Iwami T, Ono K, Nakao F, Matsuzaki M: Effect of low-intensity warfarin therapy on left atrial thrombus resolution in patients with nonvalvular atrial fibrillation: a transesophageal echocardiographic study. Jpn Circ J 2001, 65: 271-274. 10.1253/jcj.65.271CrossRefPubMed Kimura M, Wasaki Y, Ogawa H, Nakatsuka M, Wakeyama T, Iwami T, Ono K, Nakao F, Matsuzaki M: Effect of low-intensity warfarin therapy on left atrial thrombus resolution in patients with nonvalvular atrial fibrillation: a transesophageal echocardiographic study. Jpn Circ J 2001, 65: 271-274. 10.1253/jcj.65.271CrossRefPubMed
6.
go back to reference Anderson JL, Halperin JL, Albert NM, Bozkurt B, Brindis RG, Curtis LH, DeMets D, Guyton RA, Hochman JS, Kovacs RJ, Ohman EM, Pressler SJ, Sellke FW, Shen WK, Wann LS, Curtis AB, Ellenbogen KA, Estes NA 3rd, Ezekowitz MD, Jackman WM, January CT, Lowe JE, Page RL, Slotwiner DJ, Stevenson WG, Tracy CM, Fuster V, Ryden LE, Cannom DS, Crijns HJ, et al.: Management of patients with atrial fibrillation (compilation of 2006 ACCF/AHA/ESC and 2011 ACCF/AHA/HRS recommendations): a report of the American college of cardiology/American heart association task force on practice guidelines. J Am Coll Cardiol 2006, 2013(61):1935-1944. Anderson JL, Halperin JL, Albert NM, Bozkurt B, Brindis RG, Curtis LH, DeMets D, Guyton RA, Hochman JS, Kovacs RJ, Ohman EM, Pressler SJ, Sellke FW, Shen WK, Wann LS, Curtis AB, Ellenbogen KA, Estes NA 3rd, Ezekowitz MD, Jackman WM, January CT, Lowe JE, Page RL, Slotwiner DJ, Stevenson WG, Tracy CM, Fuster V, Ryden LE, Cannom DS, Crijns HJ, et al.: Management of patients with atrial fibrillation (compilation of 2006 ACCF/AHA/ESC and 2011 ACCF/AHA/HRS recommendations): a report of the American college of cardiology/American heart association task force on practice guidelines. J Am Coll Cardiol 2006, 2013(61):1935-1944.
7.
go back to reference Nair CK, Holmberg MJ, Aronow WS, Shen X, Li H, Lakkireddy D: Thromboembolism in patients with atrial fibrillation with and without left atrial thrombus documented by transesophageal echocardiography. Am J Ther 2009, 16: 385-392. 10.1097/MJT.0b013e3181727b42CrossRefPubMed Nair CK, Holmberg MJ, Aronow WS, Shen X, Li H, Lakkireddy D: Thromboembolism in patients with atrial fibrillation with and without left atrial thrombus documented by transesophageal echocardiography. Am J Ther 2009, 16: 385-392. 10.1097/MJT.0b013e3181727b42CrossRefPubMed
8.
go back to reference Habara S, Dote K, Kato M, Sasaki S, Goto K, Takemoto H, Hasegawa D, Matsuda O: Prediction of left atrial appendage thrombi in non-valvular atrial fibrillation. Eur Heart J 2007, 28: 2217-2222. 10.1093/eurheartj/ehm356CrossRefPubMed Habara S, Dote K, Kato M, Sasaki S, Goto K, Takemoto H, Hasegawa D, Matsuda O: Prediction of left atrial appendage thrombi in non-valvular atrial fibrillation. Eur Heart J 2007, 28: 2217-2222. 10.1093/eurheartj/ehm356CrossRefPubMed
9.
go back to reference Mitusch R, Siemens HJ, Garbe M, Wagner T, Sheikhzadeh A, Diederich KW: Detection of a hypercoagulable state in nonvalvular atrial fibrillation and the effect of anticoagulant therapy. Thromb Haemost 1996, 75: 219-223.PubMed Mitusch R, Siemens HJ, Garbe M, Wagner T, Sheikhzadeh A, Diederich KW: Detection of a hypercoagulable state in nonvalvular atrial fibrillation and the effect of anticoagulant therapy. Thromb Haemost 1996, 75: 219-223.PubMed
10.
go back to reference Ota S, Wada H, Nobori T, Kobayashi T, Nishio M, Nishioka Y, Noda M, Sakaguchi A, Abe Y, Nishioka J, Ishikura K, Yamada N, Nakano T: Diagnosis of deep vein thrombosis by plasma-soluble fibrin or D-dimer. Am J Hematol 2005, 79: 274-280. 10.1002/ajh.20396CrossRefPubMed Ota S, Wada H, Nobori T, Kobayashi T, Nishio M, Nishioka Y, Noda M, Sakaguchi A, Abe Y, Nishioka J, Ishikura K, Yamada N, Nakano T: Diagnosis of deep vein thrombosis by plasma-soluble fibrin or D-dimer. Am J Hematol 2005, 79: 274-280. 10.1002/ajh.20396CrossRefPubMed
11.
go back to reference Palareti G, Cosmi B, Legnani C, Tosetto A, Brusi C, Iorio A, Pengo V, Ghirarduzzi A, Pattacini C, Testa S, Lensing AW, Tripodi A: D-dimer testing to determine the duration of anticoagulation therapy. N Engl J Med 2006, 355: 1780-1789. 10.1056/NEJMoa054444CrossRefPubMed Palareti G, Cosmi B, Legnani C, Tosetto A, Brusi C, Iorio A, Pengo V, Ghirarduzzi A, Pattacini C, Testa S, Lensing AW, Tripodi A: D-dimer testing to determine the duration of anticoagulation therapy. N Engl J Med 2006, 355: 1780-1789. 10.1056/NEJMoa054444CrossRefPubMed
12.
go back to reference Ruiz-Gimenez N, Friera A, Artieda P, Caballero P, Sanchez Molini P, Morales M, Suarez C: Rapid D-dimer test combined a clinical model for deep vein thrombosis. Validation with ultrasonography and clinical follow-up in 383 patients. Thromb Haemost 2004, 91: 1237-1246.PubMed Ruiz-Gimenez N, Friera A, Artieda P, Caballero P, Sanchez Molini P, Morales M, Suarez C: Rapid D-dimer test combined a clinical model for deep vein thrombosis. Validation with ultrasonography and clinical follow-up in 383 patients. Thromb Haemost 2004, 91: 1237-1246.PubMed
13.
go back to reference Wada H, Kobayashi T, Abe Y, Hatada T, Yamada N, Sudo A, Uchida A, Nobori T: Elevated levels of soluble fibrin or D-dimer indicate high risk of thrombosis. J Thromb Haemost 2006, 4: 1253-1258. 10.1111/j.1538-7836.2006.01942.xCrossRefPubMed Wada H, Kobayashi T, Abe Y, Hatada T, Yamada N, Sudo A, Uchida A, Nobori T: Elevated levels of soluble fibrin or D-dimer indicate high risk of thrombosis. J Thromb Haemost 2006, 4: 1253-1258. 10.1111/j.1538-7836.2006.01942.xCrossRefPubMed
14.
go back to reference Wells PS, Anderson DR, Rodger M, Forgie M, Kearon C, Dreyer J, Kovacs G, Mitchell M, Lewandowski B, Kovacs MJ: Evaluation of D-dimer in the diagnosis of suspected deep-vein thrombosis. N Engl J Med 2003, 349: 1227-1235. 10.1056/NEJMoa023153CrossRefPubMed Wells PS, Anderson DR, Rodger M, Forgie M, Kearon C, Dreyer J, Kovacs G, Mitchell M, Lewandowski B, Kovacs MJ: Evaluation of D-dimer in the diagnosis of suspected deep-vein thrombosis. N Engl J Med 2003, 349: 1227-1235. 10.1056/NEJMoa023153CrossRefPubMed
15.
go back to reference Klein AL, Grimm RA, Murray RD, Apperson-Hansen C, Asinger RW, Black IW, Davidoff R, Erbel R, Halperin JL, Orsinelli DA, Porter TR, Stoddard MF: Use of transesophageal echocardiography to guide cardioversion in patients with atrial fibrillation. N Engl J Med 2001, 344: 1411-1420. 10.1056/NEJM200105103441901CrossRefPubMed Klein AL, Grimm RA, Murray RD, Apperson-Hansen C, Asinger RW, Black IW, Davidoff R, Erbel R, Halperin JL, Orsinelli DA, Porter TR, Stoddard MF: Use of transesophageal echocardiography to guide cardioversion in patients with atrial fibrillation. N Engl J Med 2001, 344: 1411-1420. 10.1056/NEJM200105103441901CrossRefPubMed
16.
go back to reference Klein AL, Murray RD, Grimm RA: Role of transesophageal echocardiography-guided cardioversion of patients with atrial fibrillation. J Am Coll Cardiol 2001, 37: 691-704. 10.1016/S0735-1097(00)01178-5CrossRefPubMed Klein AL, Murray RD, Grimm RA: Role of transesophageal echocardiography-guided cardioversion of patients with atrial fibrillation. J Am Coll Cardiol 2001, 37: 691-704. 10.1016/S0735-1097(00)01178-5CrossRefPubMed
17.
go back to reference Hori M, Matsumoto M, Tanahashi N, Momomura S, Uchiyama S, Goto S, Izumi T, Koretsune Y, Kajikawa M, Kato M, Ueda H, Iwamoto K, Tajiri M: Rivaroxaban vs. warfarin in Japanese patients with atrial fibrillation - the J-ROCKET AF study. Circ J 2012, 76: 2104-2111. 10.1253/circj.CJ-12-0454CrossRefPubMed Hori M, Matsumoto M, Tanahashi N, Momomura S, Uchiyama S, Goto S, Izumi T, Koretsune Y, Kajikawa M, Kato M, Ueda H, Iwamoto K, Tajiri M: Rivaroxaban vs. warfarin in Japanese patients with atrial fibrillation - the J-ROCKET AF study. Circ J 2012, 76: 2104-2111. 10.1253/circj.CJ-12-0454CrossRefPubMed
Metadata
Title
Resolution of left atrial appendage thrombus with apixaban
Authors
Tohru Kawakami
Hiroko Kobayakawa
Hiroyoshi Ohno
Nobukiyo Tanaka
Hiroki Ishihara
Publication date
01-12-2013
Publisher
BioMed Central
Published in
Thrombosis Journal / Issue 1/2013
Electronic ISSN: 1477-9560
DOI
https://doi.org/10.1186/1477-9560-11-26

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