Intra-ventricular thrombus resolution after anticoagulation therapy with rivaroxaban in patient with poor anticoagulation quality (original) (raw)
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Myocardial infarction associated with thrombus formation in non-culprit coronary arteries
Journal of Thrombosis and Thrombolysis, 2007
Acute coronary syndromes may be associated with a systemic acute pro-thrombotic condition, possibly involving inflammatory mechanisms as well, which are not confined to a single spot in the coronary circulation. Multivessel coronary thrombosis appears to be an exceptionally rare clinical finding. Here we present a case of anterior MI complicated by thrombi in circumflex and right coronary arteries.
Journal of Investigative Medicine High Impact Case Reports, 2017
The incidence of left ventricular (LV) thrombi in the setting of an anterior myocardial infarction has declined significantly since the advent of primary percutaneous coronary intervention coupled with contemporary antithrombotic strategies in ST-segment elevation myocardial infarctions (STE-ACS). Despite oral anticoagulation with the currently accepted, standard-of-care vitamin K antagonist, warfarin, major bleeding complications still arise. Rivaroxaban is a novel, direct oral factor X anticoagulant that has several advantageous properties, which can attenuate bleeding risk. We present a case in which a patient successfully underwent a 3-month course of rivaroxaban in addition to his dual antiplatelet regimen of aspirin and ticagrelor for his STE-ACS and LV thrombus with resultant complete dissolution.
The Gazette of Medical Sciences, 2020
The recommended treatment for ventricular thrombosis is based on vitamin K antagonists use for at least 3 months. Till now there are not completed trials that allow use of direct oral anticoagulants for this specific complication in neither chronic nor acute settings. We report the case of a subacute left ventricular apical thrombosis complicating a myocardial infarction in a 78-years-old patient effectively treated with low-dose apixaban (2.5 mg twice daily) associated with dual antithrombotic therapy. This off-label therapeutic approach was successful and no hemorrhagic complications neither thrombotic recurrences were noticed in the acute phase and at 2-years follow up. This case is the first one describing a successful and not complicated management of post-myocardial infarction ventricular thrombosis using off-label low-dose apixaban and it encourages further evidences and studies to evaluate the possibility of using this approach in the management of this kind of issues.
JRSM Cardiovascular Disease, 2019
Background Left ventricular thrombus is a frequent complication of acute myocardial infarction and a risk factor for thromboembolic complications. Warfarin has been frequently used, but has some disadvantages that limit its use. Direct oral anticoagulants, in particular Dabigatran and Rivaroxaban have been proved to be effective in preventing thromboembolism among patients with non-valvular atrial fibrillation. However, no randomized clinical trials testing the efficacy and safety of these agents in patients with existing left ventricular thrombus. Furthermore, direct oral anticoagulants are still not approved by the Food and Drug Administration in the management of left ventricular thrombus. Method This study was a retrospective cohort assessing the efficacy of direct oral anticoagulants (Dabigatran or Rivaroxaban) on the resolution of left ventricular thrombus in patients taking either of these drugs during the study period from December, 2011 to December, 2016 at King Fahad Medica...
Vojnosanitetski Pregled, 2023
Introduction. The left main stem (MS) coronary artery (CA) (MSCA) thrombosis is a rare but potentially lethal manifestation of acute coronary syndrome. The standard approach in treating such patients is the primary percutaneous coronary intervention (pPCI) or CA bypass graft surgery. In some cases, depending on the morphological appearance of the thrombus, findings and flow rates assessed on coronary angiography (CAn), clinical conditions, and cardiologist's experiences, another possible method of treatment can be the conservative approach using antithrombotic therapy. Case report. A 37-year-old male was admitted to the emergency room with symptoms of an acute myocardial infarction with an ST elevation in diaphragmal localization. Using an emergency CAn, we have visualized a thrombus at the ostial and proximal part of the left MSCA, with no complete obstruction of the blood flow. Initially, dual antithrombotic therapy (ticagrelor and acetylsalicylic acid)
Giornale italiano di cardiologia (2006), 2016
We report the case of a 65--year-old woman admitted for inferior ST-segment elevation myocardial infarction complicated by complete atrioventricular block. The patient was under treatment with a novel oral anticoagulant (NOAC, rivaroxaban) because of a history of recurrent idiopathic pulmonary embolism. Emergency angiography showed complete acute thrombotic occlusion of the right coronary artery. After manual thrombectomy, there was no angiographic evidence of underlying atherosclerosis, therefore no further percutaneous coronary intervention was performed. Subsequent clinical course was uneventful. Laboratory tests demonstrated the presence of a heterozygous mutation of the factor II gene (G20210A), confirming the clinical evidence of a thrombophilic state. As rivaroxaban seemed to be ineffective in preventing spontaneous coronary thrombosis in this patient, antithrombotic therapy was shifted to warfarin plus low-dose aspirin. No further ischemic events occurred during the 1-year f...
Pakistan Journal of Medical and Health Sciences
Aim: To investigate the association between left ventricular thrombosis (LVT) and adverse cardio-cerebrovascular events in anterior acute ST segment elevation myocardial infarction patients who had undergone primary percutaneous coronary intervention. Study design: A retrospective study. Study place and duration: From 22nd Oct 2020 to 22nd Oct 2021 at the Cardiology department of Ch.Pervaiz Elahi Institute of Cardiology Multan. Methodology: The study included patients who were identified with anterior acute ST segment elevation myocardial infarction and received primary percutaneous intervention within the first 12 hours following onset. Patients were specifically evaluated for being treated with oral vitamin K antagonists (VKA) at discharge along with their assessment of the international normalized ratio (INR). The primary endpoint was considered as the occurrence of major cardio-cerebrovascular events, the secondary endpoint was the resolution of thrombus in LVT patients within 1...
Low dose aspirin after early thrombolysis in anterior wall acute myocardial infarction
The American Journal of Cardiology, 1988
thrombolysis has become the standard treatment of patients who have transmural acute myocardial infarction (AMI) and has proven to be the most effective in anterior AM1 in terms of survival and left ventricular function.1-3 Reinfarction as a result of coronary reocclusion remains the major drawback of early thrombolysis and occurs mainly in the first 3 months after AMI Strategies to prevent reinfarction include coronary artery bypass surgery, coronary angioplasty and drug treatment. Randomized trials of surgery after thrombolysis are lacking and those involving coronary angioplasty have had negative results.4.5 We present the results of a prospective, randomized, double-blind placebo-controlled trial of low dose aspirin after early thrombolysis in patients with first anterior wall AMI.
Iatrogenic left main coronary artery thrombosis during percutaneous coronary intervention
International Journal of Cardiology, 2005
The patient was admitted to our clinic with the diagnosis of unstable angi na pectoris. In the coronary angiography, two stenoses (proxismal 90%, disto/ 60%) in the circun~flex artery (CX) were seen. Left anterior descending (LAD) and right coronary arteri es were normal. In o nother session, coronary balloon angioplasty was performed for the CX lesi on s after which a resi dua/ stenosis was detected and stent implantation was decided. Unfortunately, it was not possible to cross the proximal fesian with the 3,0XJ8 mm stent. l mmediately, after pul/ing back the stent, the patient had severe chest pain. Angiography reveo/ed a thrombotic sub-total occ/usion of left main coronary artery (LMCA). During the stent imp/antation to the LMCA fesian , the thrombus moved distal/y into the circumflex artery possibly by the mavement of the guide wire, leaving the LMCA totally free of thrombus. Accompanied by İnımediate relief of chest pain, ECG demonstrated at /east 80% resolving in the ST segment elevations. The proxima//esion in CX artery was stented and successful angioplasty was peıformed for distal/esian afterwards, resulting o Tl-M/lll flow. The patient was completely symptomfree in the follow-up period , and control angiography 1 month later reveo/ed a patent stent in CX beside normal LAD, LMCA and right coronary artery. An extremely rare, iatrogenic, subtotalleft main coronary artery thrombotic stenosis ina patient who had undergone prior PTCA-stenting of the left circumflex artery was discussed in the lig hı of the literature.