Pol. Merkur. Lek (Pol. Med. J.), 2018, XLIV/259: 019-022 Maximize

Pol. Merkur. Lek (Pol. Med. J.), 2018, XLIV/259: 019-022

Title: Fast apixaban-related resolution of left ventricular thrombi in a patient with dilated cardiomyopathy 

Authors: Elikowski W, Małek-Elikowska M, Fertała N, Zawodna M, Kruzel K.

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Fast apixaban-related resolution of left ventricular thrombi in a patient with dilated cardiomyopathy

Elikowski W1, Małek-Elikowska M2, Fertała N1, Zawodna M1, Kruzel K1.

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

Left ventricular thrombi (LVTs) develop most often in patients with post-myocardial left ventricular dysfunction and in cardiomyopathies, particularly in dilated cardiomyopathy (DCM). They constitute a danger of systemic embolization. So far, direct-acting oral anticoagulants (DOACs), including apixaban – a selective inhibitor of active Factor X, have not been systematically investigated in patients with LVTs; study comparing the efficacy of apixaban and warfarin has been undertaken only recently. A few case reports or case series presenting patients with LVTs treated with DOACs are available in the literature. The authors described a case of a 53-year-old male with DCM, hospitalized due to heart failure exacerbation. In echocardiography, apart from typical features of DCM, three apical LVTs connected with false tendons were revealed. Treatment with apixaban was introduced, initially in a dose of 2.5 mg twice daily, as creatinine concentration was 2.0 mg/dl, and after 2 days – when creatinine concentration dropped, the dose was augmented to 5 mg twice a day. Gradual resolution of LVTs was observed from day 3; they disappeared completely after one week. There were no symptoms of systemic embolization. The patient was discharged with advice to take apixaban permanently. To the best of the authors knowledge, the case presented is the fastest resolution of LVTs during therapy with apixaban reported in the literature and the first description of DOAC use for multiple LVTs.

Key words: Apixaban, left ventricular thrombus, dilated cardiomyopathy, heart failure

Pol Med J, 2018; XLIV (259); 19–22