title: Embolic stroke during apixaban therapy for left atrial appendage thrombus.
abstract: Left atrial appendage (LAA) thrombus is associated with atrial fibrillation (AF) and is a powerful predictor of cardiogenic thromboembolism. Warfarin is an established anticoagulant therapy for patients with LAA thrombus to prevent thromboembolic complications. Apixaban is superior to warfarin in the prevention of thromboembolic complications in patients with AF, and there are case reports showing apixaban-associated resolution of LAA thrombus; however, the efficacy and safety of apixaban for the treatment of LAA thrombus remains unproven. Here we report a patient who experienced embolic stroke while taking apixaban for the treatment of LAA thrombus. Thrombolysis therapy was initiated at the onset of stroke and the patient recovered remarkably. Apixaban is known to make thrombi mobile and/or fragile by shifting the coagulation/fibrinolysis balance to a relative predominance of fibrinolytic activity; therefore, it is necessary to monitor for thromboembolic complications after the initiation of apixaban for the treatment of pre-existing LAA thrombus.
authors.affiliation: Department of Internal Medicine, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan. Electronic address: ohyanuro@tmd.ac.jp.
authors.forename: Masaki
authors.initials: M
authors.lastname: Ohyagi
authors.affiliation: Department of Internal Medicine, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan.
authors.forename: Kazuha
authors.initials: K
authors.lastname: Nakamura
authors.affiliation: Department of Internal Medicine, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan.
authors.forename: Mutsufusa
authors.initials: M
authors.lastname: Watanabe
authors.affiliation: Department of Internal Medicine, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan.
authors.forename: Hiroto
authors.initials: H
authors.lastname: Fujigasaki
mesh_terms: D020517:Atrial Appendage / Q000503:physiopathology*; D038524:Diffusion Magnetic Resonance Imaging; D004452:Echocardiography; D065427:Factor Xa Inhibitors / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011720:Pyrazoles / Q000009:adverse effects*; D011728:Pyridones / Q000009:adverse effects*; D020521:Stroke / Q000139:chemically induced*; D013927:Thrombosis / Q000473:pathology*
chemical_list: D065427:Factor Xa Inhibitors; D011720:Pyrazoles; D011728:Pyridones; C522181:apixaban
keywords: Novel oral anticoagulants; atrial fibrillation; echocardiography; thrombolysis