title: Resolution of massive left atrial appendage thrombi with rivaroxaban before balloon mitral commissurotomy in severe mitral stenosis: A case report and literature review.
abstract: BACKGROUND
  Data on nonvitamin K antagonist oral anticoagulant being used for the treatment of LAA thrombi are limited only in nonvalvular atrial fibrillation. There are no data on the antithrombotic efficacy and safety of nonvitamin K antagonist oral anticoagulant in the resolution of left atrial appendage (LAA) thrombi in patients with rheumatic mitral stenosis.
  
  
  METHODS
  A 49-year-old woman with known rheumatic mitral stenosis and atrial fibrillation was referred for percutaneous transvenous mitral commissurotomy because of progressive dyspnea on exertion over a period of 3 months.
  
  
  METHODS
  Transesophageal echocardiography (TEE) demonstrated a large LAA thrombus protruding into left atria cavity before the procedure.
  
  
  METHODS
  Direct factor Xa (FXa) inhibitor rivaroxaban (20 mg/d) was started for the patient. After 3 weeks of rivaroxaban treatment TEE showed a relevantly decreased thrombus size, and a complete thrombus resolution was achieved after 5 weeks of anticoagulant therapy with the FXa inhibitor.
  
  
  RESULTS
  To the best of our knowledge, this is the first documented case of large LAA thrombus resolution with nonvitamin K antagonist oral anticoagulant in severe mitral stenosis, and in which percutaneous transvenous mitral commissurotomy was performed subsequently.
  
  
  CONCLUSIONS
  The report indicated that rivaroxaban could be a therapeutic option for mitral stenosis patients with LAA thrombus. Further study is required before the routine use of rivaroxaban in patients with rheumatic mitral stenosis and atrial fibrillation.
authors.affiliation: Department of Cardiology, Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.
authors.forename: Yuechun
authors.initials: Y
authors.lastname: Li
authors.forename: Jiafeng
authors.initials: J
authors.lastname: Lin
authors.forename: Chen
authors.initials: C
authors.lastname: Peng
mesh_terms: D020517:Atrial Appendage / Q000187:drug effects* / Q000473:pathology; D006348:Cardiac Surgical Procedures / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D008946:Mitral Valve Stenosis / Q000175:diagnosis / Q000601:surgery*; D011300:Preoperative Care / Q000379:methods; D018570:Risk Assessment; D000069552:Rivaroxaban / Q000008:administration & dosage*; D012720:Severity of Illness Index; D013927:Thrombosis / Q000188:drug therapy* / Q000473:pathology; D016896:Treatment Outcome
chemical_list: D000069552:Rivaroxaban