title: Reduced smoke-like echo and resolved thrombus in the left atrium with rivaroxaban therapy in an acute cardioembolic stroke patient.
abstract: We report a case of a nonvalvular atrial fibrillation (NVAF) patient with acute cardioembolic stroke in whom rivaroxaban, an oral direct factor Xa inhibitor, reduced a smoke-like echo in the left atrium and resolved a thrombus in the left atrial appendage. A 71-year-old man was admitted because of the sudden onset of right hemiplegia and aphasia and was diagnosed with acute cardioembolic stroke associated with NVAF. The patient had not been treated with warfarin before admission, and rivaroxaban therapy (15 mg once daily) was initiated. Transesophageal echocardiography was performed on day 8 and a mobile thrombus was found in the left atrial appendage, accompanied by a remarkable smoke-like echo in the left atrium. Notably, the thrombus was resolved and the smoke-like echo was reduced on day 40. No recurrent ischemic stroke occurred. We describe favorable effects of rivaroxaban on the reduction of a smoke-like echo and on the resolution of a thrombus in the left atrium in an NVAF patient with acute cardioembolic stroke.
authors.affiliation: Hirosaki Stroke and Rehabilitation Center, Hirosaki, Japan. Electronic address: shinpompom@gmail.com.
authors.forename: Shin
authors.initials: S
authors.lastname: Saito
authors.affiliation: Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Tomita
authors.affiliation: Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Kimura
authors.affiliation: Hirosaki Stroke and Rehabilitation Center, Hirosaki, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Shiroto
authors.affiliation: Hirosaki Stroke and Rehabilitation Center, Hirosaki, Japan.
authors.forename: Joji
authors.initials: J
authors.lastname: Hagii
authors.affiliation: Hirosaki Stroke and Rehabilitation Center, Hirosaki, Japan.
authors.forename: Norifumi
authors.initials: N
authors.lastname: Metoki
authors.affiliation: Hirosaki Stroke and Rehabilitation Center, Hirosaki, Japan.
authors.forename: Hiroyasu
authors.initials: H
authors.lastname: Hitomi
authors.affiliation: Hirosaki Stroke and Rehabilitation Center, Hirosaki, Japan.
authors.forename: Takaatsu
authors.initials: T
authors.lastname: Kamada
authors.affiliation: Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan; Hypertension and Stroke Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Osanai
authors.affiliation: Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan; Hypertension and Stroke Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
authors.forename: Ken
authors.initials: K
authors.lastname: Okumura
authors.affiliation: Hirosaki Stroke and Rehabilitation Center, Hirosaki, Japan.
authors.forename: Minoru
authors.initials: M
authors.lastname: Yasujima
mesh_terms: D000368:Aged; D017548:Echocardiography, Transesophageal; D004617:Embolism / Q000000981:diagnostic imaging / Q000188:drug therapy*; D065427:Factor Xa Inhibitors / Q000494:pharmacology / Q000627:therapeutic use*; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000187:drug effects*; D006801:Humans; D008297:Male; D009025:Morpholines / Q000494:pharmacology / Q000627:therapeutic use*; D000069552:Rivaroxaban; D020521:Stroke / Q000000981:diagnostic imaging / Q000188:drug therapy*; D013876:Thiophenes / Q000494:pharmacology / Q000627:therapeutic use*; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D065427:Factor Xa Inhibitors; D009025:Morpholines; D013876:Thiophenes; D000069552:Rivaroxaban
keywords: Rivaroxaban—nonvalvular atrial fibrillation; reduction of a smoke-like echo; resolution of a thrombus