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Oral factor Xa inhibitors for the treatment of left ventricular thrombus: a case series

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Abstract

Left ventricular thrombus (LVT) formation usually necessitates short term anticoagulation for thrombus resolution and to prevent embolic events. Historically, vitamin K antagonist therapy has been the treatment of choice. However, with the advent of direct acting anticoagulants, their role in the management of LVT is not clear. Patients were included if they had received rivaroxaban or apixaban for more than 1 day for LVT documented on imaging. The primary objective was resolution of LVT at 3 months based on assessment by an independent cardiologist review of initial and subsequent imaging results. The principle safety objective was to assess major or clinically relevant non-major bleeding using GUSTO, TIMI, and BARC bleeding criteria. During the 2-year study period seven patients were treated with rivaroxaban and three with apixaban. Two patients who had received apixaban and one on rivaroxaban were lost to follow up. In those with an initial and follow-up ECHO (n = 6) the median time to follow up imaging was 214 (IQR 33–414) days and complete LVT resolution was observed in 83% of patients. One patient on rivaroxaban had a bleeding events that was minimal (TIMI), Type 2 (BARC), or classified as mild (GUSTO) due to pulmonary hemorrhage. In those deemed not to be a candidate for vitamin K antagonist the use of rivaroxaban or apixaban may be a considered in the treatment of LVT. Further research in this area is needed to assess the efficacy and safety of using FXAI for treatment of LVT.

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Funding

No funding was obtained for the conduction of this study.

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Authors and Affiliations

  1. Department of Pharmaceutical Services, The Ohio State University Wexner Medical Center, 410 W. 10th Ave, Doan Hall Room 368, Columbus, OH, 43210, USA

    Keaton S. Smetana

  2. Department of Pharmaceutical Services, University of Kentucky HealthCare, 800 Rose Street, H110, Lexington, KY, 40536, USA

    Jessie Dunne, George A. Davis & Mary Covell

  3. Division of Cardiovascular Medicine, Gill Heart and Vascular Institute, 900 S Limestone Street, Lexington, KY, 40536, USA

    Kevin Parrott & Susan Smyth

  4. Department of Internal Medicine, University of Kentucky HealthCare, 900 S Limestone Street, Lexington, KY, 40536, USA

    Amy C. Schmelzer Collier

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  1. Keaton S. Smetana
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  2. Jessie Dunne
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Correspondence to Keaton S. Smetana.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Smetana, K.S., Dunne, J., Parrott, K. et al. Oral factor Xa inhibitors for the treatment of left ventricular thrombus: a case series. J Thromb Thrombolysis 44, 519–524 (2017). https://doi.org/10.1007/s11239-017-1560-7

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