RATIONALE: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. PATIENT CONCERNS: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. DIAGNOSES:Transesophageal echocardiography (TEE) demonstrated a large LAA thrombus protruding into left atria cavity before the procedure. INTERVENTIONS: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. OUTCOMES: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. LESSONS: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.

译文

理由:仅用于非瓣膜性房颤的非维生素K拮抗剂口服抗凝剂用于治疗LAA血栓的数据有限。目前尚无关于非维生素K拮抗剂口服抗凝剂对风湿性二尖瓣狭窄患者左心耳(LAA)血栓形成的抗血栓形成功效和安全性的数据。
患者担忧:一名49岁的已知风湿性二尖瓣狭窄和心房纤颤的妇女因在3个月的劳累期间进行性呼吸困难而接受经皮经皮二尖瓣合缝术。
诊断:经食道超声心动图(TEE)证实,术前有较大的LAA血栓伸入左心房腔。
干预措施:患者开始使用直接因子Xa(FXa)抑制剂利伐沙班(20 mg / d)。利伐沙班治疗3周后,TEE显示血栓大小相应减少,用FXa抑制剂进行抗凝治疗5周后,血栓完全消退。
结果:就我们所知,这是首次记录的严重二尖瓣狭窄合并非维生素K拮抗剂口服抗凝剂的大面积LAA血栓形成病例,随后进行了经皮经皮静脉二尖瓣合缝术。
经验教训:该报告指出,利伐沙班可以作为二尖瓣狭窄合并LAA血栓的患者的治疗选择。风湿性二尖瓣狭窄和房颤患者常规使用利伐沙班之前,需要进一步研究。

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