Reversal of bioprosthetic aortic valve thrombrosis using rivaroxaban- a case report

Harish Sharma; Vincenzo Vetrugno; Peter Ludman

doi:10.3389/fcvm.2020.00087

Reversal of bioprosthetic aortic valve thrombrosis using rivaroxaban- a case report

Harish Sharma, Vincenzo Vetrugno, Peter Ludman

Cardiovascular Sciences

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Abstract

Background: Bioprosthetic valve thrombosis (BPVT) is a rare but recognized complication causing valve dysfunction. In subacute valve thrombosis, systemic oral anticoagulation is recommended. However, there is little data comparing the efficacy of warfarin and novel oral anticoagulant (NOAC) therapy in this setting.

Case Summary: A patient developed subacute BPVT 11 years post-implantation. The patient was initially treated with warfarin for a period of 6 months, with limited effect. Following replacement of warfarin with rivaroxaban, there was significant reversal of the BPVT, as represented by a reduction in transaortic maximal velocity (Vmax) from 4.1 to 3 m/s over 7 months.

Discussion: Systemic oral anticoagulation can be an effective treatment for subacute valve thrombosis. Guidelines currently recommend warfarin as first line but NOACs can be considered in such patients and may be more effective than warfarin. Randomized controlled trials are required to further establish the optimal anticoagulation for patients with subacute BPVT.

Original language	English
Article number	87
Number of pages	5
Journal	Frontiers in cardiovascular medicine
Volume	7
DOIs	https://doi.org/10.3389/fcvm.2020.00087
Publication status	Published - 27 May 2020

Keywords

rivaroxaban
valve thrombosis
thrombosis reversal
Bioprosthetic aortic valve
NOAC

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Cite this

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title = "Reversal of bioprosthetic aortic valve thrombrosis using rivaroxaban- a case report",

abstract = "Background: Bioprosthetic valve thrombosis (BPVT) is a rare but recognized complication causing valve dysfunction. In subacute valve thrombosis, systemic oral anticoagulation is recommended. However, there is little data comparing the efficacy of warfarin and novel oral anticoagulant (NOAC) therapy in this setting.Case Summary: A patient developed subacute BPVT 11 years post-implantation. The patient was initially treated with warfarin for a period of 6 months, with limited effect. Following replacement of warfarin with rivaroxaban, there was significant reversal of the BPVT, as represented by a reduction in transaortic maximal velocity (Vmax) from 4.1 to 3 m/s over 7 months.Discussion: Systemic oral anticoagulation can be an effective treatment for subacute valve thrombosis. Guidelines currently recommend warfarin as first line but NOACs can be considered in such patients and may be more effective than warfarin. Randomized controlled trials are required to further establish the optimal anticoagulation for patients with subacute BPVT.",

keywords = "rivaroxaban, valve thrombosis, thrombosis reversal, Bioprosthetic aortic valve, NOAC",

author = "Harish Sharma and Vincenzo Vetrugno and Peter Ludman",

year = "2020",

month = may,

day = "27",

doi = "10.3389/fcvm.2020.00087",

language = "English",

volume = "7",

journal = "Frontiers in cardiovascular medicine",

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T1 - Reversal of bioprosthetic aortic valve thrombrosis using rivaroxaban- a case report

AU - Sharma, Harish

AU - Vetrugno, Vincenzo

AU - Ludman, Peter

PY - 2020/5/27

Y1 - 2020/5/27

N2 - Background: Bioprosthetic valve thrombosis (BPVT) is a rare but recognized complication causing valve dysfunction. In subacute valve thrombosis, systemic oral anticoagulation is recommended. However, there is little data comparing the efficacy of warfarin and novel oral anticoagulant (NOAC) therapy in this setting.Case Summary: A patient developed subacute BPVT 11 years post-implantation. The patient was initially treated with warfarin for a period of 6 months, with limited effect. Following replacement of warfarin with rivaroxaban, there was significant reversal of the BPVT, as represented by a reduction in transaortic maximal velocity (Vmax) from 4.1 to 3 m/s over 7 months.Discussion: Systemic oral anticoagulation can be an effective treatment for subacute valve thrombosis. Guidelines currently recommend warfarin as first line but NOACs can be considered in such patients and may be more effective than warfarin. Randomized controlled trials are required to further establish the optimal anticoagulation for patients with subacute BPVT.

AB - Background: Bioprosthetic valve thrombosis (BPVT) is a rare but recognized complication causing valve dysfunction. In subacute valve thrombosis, systemic oral anticoagulation is recommended. However, there is little data comparing the efficacy of warfarin and novel oral anticoagulant (NOAC) therapy in this setting.Case Summary: A patient developed subacute BPVT 11 years post-implantation. The patient was initially treated with warfarin for a period of 6 months, with limited effect. Following replacement of warfarin with rivaroxaban, there was significant reversal of the BPVT, as represented by a reduction in transaortic maximal velocity (Vmax) from 4.1 to 3 m/s over 7 months.Discussion: Systemic oral anticoagulation can be an effective treatment for subacute valve thrombosis. Guidelines currently recommend warfarin as first line but NOACs can be considered in such patients and may be more effective than warfarin. Randomized controlled trials are required to further establish the optimal anticoagulation for patients with subacute BPVT.

KW - rivaroxaban

KW - valve thrombosis

KW - thrombosis reversal

KW - Bioprosthetic aortic valve

KW - NOAC

U2 - 10.3389/fcvm.2020.00087

DO - 10.3389/fcvm.2020.00087

M3 - Article

C2 - 32528978

SN - 2297-055X

VL - 7

JO - Frontiers in cardiovascular medicine

JF - Frontiers in cardiovascular medicine

M1 - 87

ER -

Reversal of bioprosthetic aortic valve thrombrosis using rivaroxaban- a case report

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Keywords

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