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

Keaton S. Smetana, Jessie Dunne, Kevin Parrott, George A. Davis, Amy C.Schmelzer Collier, Mary Covell, Susan Smyth

Research output: Contribution to journalArticlepeer-review

23 Scopus citations


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.

Original languageEnglish
Pages (from-to)519-524
Number of pages6
JournalJournal of Thrombosis and Thrombolysis
Issue number4
StatePublished - Nov 1 2017

Bibliographical note

Publisher Copyright:
© 2017, Springer Science+Business Media, LLC.


  • Apixaban
  • Factor Xa inhibitors
  • Left ventricle
  • Rivaroxaban
  • Thrombosis

ASJC Scopus subject areas

  • Hematology
  • Cardiology and Cardiovascular Medicine


Dive into the research topics of 'Oral factor Xa inhibitors for the treatment of left ventricular thrombus: a case series'. Together they form a unique fingerprint.

Cite this