Rivaroxaban for treatment of left ventricular thrombus: A case report

Juhaina Salim Al-Maqbali, Maitha Al-Sibani, Nasiba Al-Maqrashi, Abdullah M. Al Alawi*, Hatim Al Lawati

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Objective: Background: Case Report: Conclusions: Unusual clinical course Left ventricular thrombus (LVT) is a complication of left ventricular dysfunction and myocardial infarction (MI) and is associated with systemic thromboembolism. Two-dimensional transthoracic echocardiography (TTE) is considered the first-line diagnostic tool for detection of LVT. Vitamin K antagonists (VKA) targeting an international normalized ratio (INR) from 2 to 3 are the only approved treatments by the Food and Drug Administration (FDA). New emerging observational data support the use of direct oral anticoagulants (DOACs) as an alternative therapeutic option; however, their safety and efficacy have not been assessed in a good-quality randomized controlled trial. Here, we present a case of a 43-year-old man diagnosed with human immunodeficiency virus (HIV)-associated dilated cardiomyopathy complicated with an LVT. He was treated with rivaroxaban for 9 consecutive months with no interruption of therapy at any point in time; however, he presented to the emergency department with symptoms of decompensated heart failure. A follow-up TTE demonstrated a significant increase in the size of his LVT. This case questions the efficacy of using factor Xa inhibitor (rivaroxaban) as an alternative option for LVT treatment. This case demonstrates a failure of rivaroxaban in treating LVT in a patient with HIV-associated dilated cardiomyopathy. Good-quality randomized clinical trials or prospective studies are required to establish the efficacy and safety of DOACs for LVT treatment as an alternative to VKA.

Original languageEnglish
Article numbere932140
JournalAmerican Journal of Case Reports
Issue number1
Publication statusPublished - 2021


  • Atrial Flutter
  • Cardiomyopathy, Dilated
  • Embolism and Thrombosis
  • Factor Xa Inhibitors
  • Thrombosis
  • Warfarin

ASJC Scopus subject areas

  • Medicine(all)

Cite this