ArticleJACC. Case reports2025
Discordant Antithrombotic Effects of Apixaban in Fibrillating Left Atria vs Post-Myocardial Infarction Left Ventricular Aneurysm.
Article in JACC. Case reports, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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10 authors.
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Abstract
backgroundDespite the high prevalence of left ventricular thrombus (LVT) complicated by acute myocardial infarction (AMI), the optimal anticoagulant remains controversial. CASE SUMMARY: An 84-year-old woman with atrial fibrillation developed an LVT and a left atrial appendage thrombus (LAAT) 2 months after AMI during suboptimal warfarin therapy. The optimization of warfarin resulted in the resolution of both thrombi, and apixaban was introduced as a safer prophylaxis. While LAAT was successfully suppressed, LVT recurred within a few days. Resuming warfarin resolved the LVT. DISCUSSION: We experienced an interesting case of simultaneous LVT and LAAT formation after AMI in which apixaban showed discordant antithrombotic effects. This suggests that the characteristics of both thrombi may differ, and the optimal anticoagulation for LVT may vary on a case-by-case basis. TAKE-HOME MESSAGES: A one-size-fits-all approach in treating LVT may need to be reconsidered, and anticoagulation therapy should be tailored based on its efficacy.
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