Reduced dose apixaban resolving dual cardiac chamber thrombi in a patient with ischaemic cardiomyopathy in sinus rhythm

Left atrial (LA) thrombus is a known sequela of atrial fibrillation (AF) but it is less frequently encountered in patients in sinus rhythm. Left ventricular (LV) dysfunction may predispose patients without evidence of atrial tachyarrhythmias to atrial thrombosis. Warfarin is the standard treatment for cardiac chamber thrombosis and prevention of the associated thromboembolic complications. Despite that apixaban was found to be superior to warfarin in prevention of stroke and systemic embolism in patients with AF, evidence for its use in treatment of cardiac chamber thrombi is scarce and is limited to case reports. We report a case of simultaneously occurring LV and LA thrombi successfully treated with reduced dose apixaban in a patient with ischaemic cardiomyopathy and in sinus rhythm. Although apixaban maybe a potential effective treatment for intracardiac thrombi, further studies are needed to demonstrate efficacy and safety of this agent in larger patient populations.

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