title: [Rivaroxaban-resistant right ventricular thrombus, successfully treated with vitamin K antagonist in a patient with dilated cardiomyopathy].
abstract: Rivaroxaban, a selective inhibitor of active factor X belongs to the group of direct-acting oral anticoagulants (DOAC), more and more often replacing vitamin K antagonists (VKA) in venous thromboembolic disease and nonvalvular atrial fibrillation. Attempts are also being made to use DOAC to treat locally formed intracardiac thrombi, mainly in the left atrium and its appendage, in atrial fibrillation and in heart failure. Rarely diagnosed local right ventricular thrombus (RVT) may be a complication of dilated cardiomyopathy (DCM).
  
  
  METHODS
  The authors present a case of a 40-year-old male with DCM and RVT located in the apex, which was imaged in echocardiography, magnetic resonance and multislice computed tomography. During treatment with rivaroksaban (2x15 mg: 4 weeks; 1x20 mg: 4 months) diminishing of RVT was not observed. After 2 months of VKA use complete resolution of RVT was noted. The case presented is probably the first described RVT treated with rivaroxaban. The authors conclude that in some cases, anticoagulation with VKA may be more effective than DOAC in intracardiac thrombi therapy, especially when it is meticulously monitored. Overlapping effect on RVT due to anticoagulants use with a different mechanism of action cannot be excluded.
authors.affiliation: Józef Struś Hospital, Poznań, Poland: Department of Internal Medicine.
authors.forename: Waldemar
authors.initials: W
authors.lastname: Elikowski
authors.affiliation: Karol Marcinkowski University of Medical Sciences, Poznań, Poland: 2nd Department of Cardiology.
authors.forename: Małgorzata
authors.initials: M
authors.lastname: Małek-Elikowska
authors.affiliation: Józef Struś Hospital, Poznań, Poland: Department of Cardiology.
authors.forename: Marek
authors.initials: M
authors.lastname: Słomczyński
authors.affiliation: Józef Struś Hospital, Poznań, Poland: Department of Cardiology.
authors.forename: Teresa
authors.initials: T
authors.lastname: Ganowicz-Kaatz
authors.affiliation: Józef Struś Hospital, Poznań, Poland: Department of Cardiology.
authors.forename: Andrzej
authors.initials: A
authors.lastname: Bolewski
authors.affiliation: Józef Struś Hospital, Poznań, Poland: Radiology Unit.
authors.forename: Paweł
authors.initials: P
authors.lastname: Skrzywanek
mesh_terms: D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use*; D002311:Cardiomyopathy, Dilated / Q000188:drug therapy*; D003328:Coronary Thrombosis / Q000188:drug therapy*; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D008297:Male; D011044:Poland; D000069552:Rivaroxaban / Q000627:therapeutic use*; D016896:Treatment Outcome; D014812:Vitamin K / Q000037:antagonists & inhibitors* / Q000627:therapeutic use*
chemical_list: D000925:Anticoagulants; D014812:Vitamin K; D000069552:Rivaroxaban
keywords: dilated cardiomyopathy; right ventricular thrombus; rivaroxaban; vitamin K antagonist