Rivaroxaban
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Lack of drug effect in left ventricular thrombus: case report A 50-year-old man exhibited a lack of drug effect during treatment with rivaroxaban for left ventricular thrombus. The man had a history of arterial hypertension, well-controlled diabetes mellitus, heart failure, implantable cardioverterdefibrillator, hyperlipidaemia, alcoholic liver cirrhosis, chronic punctuated infarcts of the right occipital lobe, left superior cerebellum and left superior frontal gyrus, and nonischemic dilated cardiomyopathy complicated by left ventricular (LV)thrombus formation. Initially, LV thrombus formation was treated with warfarin and showed successful thrombus resolution. But, warfarin was switched to oral rivaroxaban [dosage not stated] due to difficulties in maintaining a steady therapeutic international INR level. After 2 months, he presented to the hospital with sudden onset of altered mental status and right-sided weakness. Upon admission, he was found to have right hemiplegia, lethargy, aphasia, spatial neglect to the right side, gaze preference to the left and Glasgow coma scale 10 to 15. Eye examination revealed equal and round pupils reactive to light. Head investigations showed left M1 occlusion, acute left occipital and left middle cerebral artery territory infarcts. Echocardiography revealed a large apical LV thrombus. The man was started on heparin based on the findings of LV thrombus and high risk for recurrent stroke. However, his condition deteriorated 6 hours after starting heparin. He developed acute respiratory failure and was intubated [etiology not stated]. He showed absences of gag, pupillary and corneal reflexes. Repeat head CT showed massive parenchymal haemorrhage and vasogenic oedema with a left to right 2cm midline shift. The haemorrhage extended into the bilateral lateral ventricles along with enlargement of lateral ventricles [etiologies not stated]. Ghani U, et al. Recurrent Left Ventricular Thrombus Formation on Rivaroxaban Therapy in Cardiomyopathy and Liver Cirrhosis. JACC: Case Reports 2: 1501-1504, No. 10, 803504738 Aug 2020. Available from: URL: http://doi.org/10.1016/j.jaccas.2020.05.094
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Reactions 3 Oct 2020 No. 1824
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