EFFICACY OF DIRECT ORAL ANTICOAGULANTS IN MANAGING LEFT VENTRICULAR THROMBUS ASSOCIATED WITH NONCOMPACTION CARDIOMYOPATHY: A CASE REPORT
Keywords:
Noncompaction cardiomyopathy, Left ventricular thrombus, Direct oral anticoagulants, RivaroxabanAbstract
Noncompaction cardiomyopathy (NCC) is a rare and often puzzling heart condition where the heart muscle develops in an unusual, spongy way. This unique structure, unfortunately, can create a breeding ground for blood clots (left ventricular thrombus or LVT), which pose a serious risk of stroke and other embolic events. While warfarin has long been the go-to medication for these clots, newer direct oral anticoagulants (DOACs) offer a more patient-friendly option. This report shares the story of a 45-year-old man with NCC who developed a significant LVT, and how we successfully treated it with rivaroxaban, a type of DOAC. Through detailed heart scans (echocardiography and cardiac magnetic resonance imaging), we confirmed his NCC and found a large clot (2.5 cm x 1.8 cm) in his heart's main pumping chamber. After starting him on rivaroxaban 20 mg once daily, follow-up scans just eight weeks later showed the clot had completely vanished, with no side effects like bleeding. This case offers encouraging evidence that DOACs, like rivaroxaban, can be a safe and effective way to clear these dangerous clots in NCC patients, potentially offering a simpler alternative to traditional treatments. We believe more extensive research is needed to solidify these findings and guide future treatment decisions.
References
1. R. H. Feldt, S. H. Rahimtoola, G. D. Davis, H. J. C. Swan, and J. L. Titus, “Anomalous Ventricular Myocardial Patterns in a Child With Complex Congenital Heart Disease,” American Journal of Cardiology 23 (1969): 732–734.
2. R. Ronderos, G. Avegliano, E. Borelli, et al., “Estimation of Prevalence of the Left Ventricular Noncompaction Among Adults,” American Journal of Cardiology 118 (2016): 901–905.
3. S. B. Ross, K. Jones, B. Blanch, et al., “A Systematic Review and Meta-Analysis of the Prevalence of Left Ventricular Noncompaction in Adults,” European Heart Journal 41 (2020): 1428–1436, https://doi.org/10.1093/eurheartj/ehz317.
4. P. Richard, F. Ader, M. Roux, et al., “Targeted Panel Sequencing in Adult Patients With Left Ventricular Noncompaction Reveals a Large Genetic Heterogeneity,” Clinical Genetics 95 (2019): 356–367.
5. A. Frustaci, N. Galea, R. Verardo, et al., “Kappa- Light Chain Amyloid Overlapping Hypertrophic Cardiomyopathy With Myocardial Noncompaction,” Circulation. Cardiovascular Imaging 13 (2020): e010379.
6. R. Jenni, “Echocardiographic and Pathoanatomical Characteristics of Isolated Left Ventricular Noncompaction: A Step Towards Classification as a Distinct Cardiomyopathy,” Heart 86 (2001): 666–671.
7. S. E. Petersen, J. B. Selvanayagam, F. Wiesmann, et al., “Left Ventricular Noncompaction,” Journal of the American College of Cardiology 46 (2005): 101–105.
8. A. Jacquier, F. Thuny, B. Jop, et al., “Measurement of Trabeculated Left Ventricular Mass Using Cardiac Magnetic Resonance Imaging in the Diagnosis of Left Ventricular Noncompaction,” European Heart Journal 31 (2010): 1098–1104.
9. J. A. Towbin, A. Lorts, and J. L. Jefferies, “Left Ventricular Noncompaction Cardiomyopathy,” Lancet 386 (2015): 813–825.
10. C. Stöllberger, C. Wegner, and J. Finsterer, “CHADS2- and CHA2DS-2VASc Scores and Embolic Risk in Left Ventricular Hypertrabeculation/Noncompaction,” Journal of Stroke and Cerebrovascular Diseases 22 (2013): 709–712.
11. C. Stöllberger, G. Blazek, C. Dobias, A. Hanafin, C. Wegner, and J. Finsterer, “Frequency of Stroke and Embolism in Left Ventricular Hypertrabeculation/ Noncompaction,” American Journal of Cardiology 108 (2011): 1021–1023.
12. C. Chimenti, C. Lavalle, M. Magnocavallo, et al., “A Proposed Strategy for Anticoagulation Therapy in Noncompaction Cardiomyopathy,” ESC Heart Fail 9 (2022): 241–250, https://doi.org/10.1002/ehf2.13694.
13. M. Maqsood, R. Zhang, and S. Bangalore, “Direct Oral Anticoagulants or Warfarin in Patients With Left Ventricular Thrombus: A Meta-Analysis of Randomized Clinical Trials,” European Heart Journal 45, no. Supplement_1 (2024): ehae666.3324, https://doi.org/10.1093/eurheartj/ehae666.3324.
14. H. Sun, Q. Zhao, Y. Wang, et al., “Daily 10 Mg Rivaroxaban as a Therapy for Ventricular Thrombus Related to Left Ventricular Noncom-paction Cardiomyopathy: A Case Report,” Medicine 97 (2018): e9670.