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Pol. Merkur. Lek (Pol. Med. J.), 2018, XLIV/264: 276-279 Maximize

Pol. Merkur. Lek (Pol. Med. J.), 2018, XLIV/264: 276-279

Title: Apixaban in left ventricular thrombi treatment – a report of seven cases 

Authors: Elikowski W, Małek-Elikowska M, Wróblewski D, Fertała N, Zawodna M, Lachowska-Kotowska P, Skommer K.

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Apixaban in left ventricular thrombi treatment – a report of seven cases


Elikowski W1, Małek-Elikowska M2, Wróblewski D1, Fertała N1, Zawodna M1, Lachowska-Kotowska P1, Skommer K1.

1Department of Internal Medicine, Józef Struś Hospital, Poznań, Poland; 22nd Department of Cardiology, Poznań University of Medical Sciences, Poland

Treatment of intracardiac thrombi (ICTs) with direct-acting oral anticoagulants (DOACs) constitutes a new challenge for this group of medications. Left ventricular thrombi (LVTs) occur mainly in patients with severe left ventricular dysfunction. Advanced heart failure is characterized by a high prevalence of chronic kidney disease (CKD). Apixaban has the best renal profile among all DOACs.
The authors describe a group of 7 patients with LVTs treated with apixaban; 6 of them had CKD. LVTs were screened and monitored during therapy using a sector, 3-dimensional and high frequency linear probes; the latter to exclusively assess the left ventricular apex. Examination was performed every day during the first 2 weeks, then 2-3 times a week until LVTs disappearance, then every month; transesophageal assessment was done initially and repeated when necessary. Patients , mean age was 65 years. The underlying disease was post-myocardial left ventricular dysfunction (3), dilated cardiomyopathy (3) and heart failure of unknown etiology (1).Three patients had more than one LVT. Also, three had other ICTs, one – in the right ventricle, two – in the left atrial appendage. Three patients used apixaban in a dose of 5 mg twice daily, two – 2.5 mg twice a day, two – in an increasing dose. In all patients, gradual diminishing of LVTs was observed, no complications of apixaban therapy were noted. The time needed for LVTs disappearance was between 7 and 28 days (mean: 17 days).

Key words: apixaban, left ventricular thrombus, left ventricular dysfunction, heart failure, chronic kidney disease

Pol Med J, 2018; XLIV (264); 276–279