title: Rivaroxaban as an effective alternative to warfarin in a patient with atrial fibrillation, thrombophilia, and left atrial appendage thrombus: a case report.
abstract: BACKGROUND
  Atrial fibrillation is the most common cardiac arrhythmia. It is responsible for up to 20% of all ischemic strokes. Rate control and anticoagulation are crucial for atrial fibrillation management and stroke prevention.
  
  
  METHODS
  We present the case of an 84-year-old Italian woman with a left atrial appendage thrombus that developed despite her use of anticoagulant therapy with warfarin for a previous pulmonary embolism. She had atrial fibrillation and heterozygosity for both factor V Leiden and methylenetetrahydrofolate reductase C677T mutation, thus creating resistance to activated protein C. Anticoagulant therapy was switched to heparin for 1 week and then to rivaroxaban. After 3 months of rivaroxaban use, the thrombus disappeared.
  
  
  CONCLUSIONS
  This case raises the issue of the ineffectiveness of warfarin therapy in complex cases involving particular thrombophilic conditions and the possibility of using rivaroxaban as a safe and effective alternative.
authors.affiliation: Cardiology Unit, Emergency Department, Hospital "Madonna del Soccorso", Via Silvio Pellico n.32, 63039, San Benedetto del Tronto, Ascoli Piceno, Italy. michelescarano1978@gmail.com.
authors.forename: Michele
authors.initials: M
authors.lastname: Scarano
authors.affiliation: Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Casale
authors.affiliation: "Gabriele D'Annunzio" University, Chieti, Italy.|Ospedale SS. Annunziata, Chieti, Italy.
authors.forename: Cesare
authors.initials: C
authors.lastname: Mantini
authors.affiliation: Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
authors.forename: Egidio
authors.initials: E
authors.lastname: Imbalzano
authors.affiliation: Cardiology Unit, Emergency Department, Hospital "Madonna del Soccorso", Via Silvio Pellico n.32, 63039, San Benedetto del Tronto, Ascoli Piceno, Italy.
authors.forename: Cristiana
authors.initials: C
authors.lastname: Consorti
authors.affiliation: Cardiology Unit, Emergency Department, Hospital "Madonna del Soccorso", Via Silvio Pellico n.32, 63039, San Benedetto del Tronto, Ascoli Piceno, Italy.
authors.forename: Daniela
authors.initials: D
authors.lastname: Clemente
authors.affiliation: Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Dattilo
mesh_terms: D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D020517:Atrial Appendage / Q000000981:diagnostic imaging* / Q000473:pathology; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000503:physiopathology; D005260:Female; D006801:Humans; D000069552:Rivaroxaban / Q000627:therapeutic use*; D013927:Thrombosis / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000473:pathology; D016896:Treatment Outcome; D014859:Warfarin / Q000008:administration & dosage / Q000009:adverse effects*
chemical_list: D000925:Anticoagulants; D014859:Warfarin; D000069552:Rivaroxaban
keywords: Atrial fibrillation; Case report; Rivaroxaban; Thrombophilia; Thrombosis; Warfarin