Resolving Thrombus in the Left Atrial Appendage by Edoxaban Treatment after Acute Ischemic Stroke: Report of 2 Cases

• Published in: Journal of stroke and cerebrovascular diseases Vol. 25; no. 10; pp. e188 - e191
• Main Authors: Saito, Shin, MD, PhD, Shindo, Seigo, MD, Tsudaka, Shun, MD, Uchida, Kazutaka, MD, Shirakawa, Manabu, MD, PhD, Yoshimura, Shinichi, MD, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.10.2016
• Subjects: Aged, 80 and over; Angiography, Digital Subtraction; Atrial Appendage - diagnostic imaging; Atrial Appendage - drug effects; atrial fibrillation; Atrial Fibrillation - complications; Atrial Fibrillation - diagnosis; Brain Ischemia - diagnostic imaging; Brain Ischemia - etiology; Brain Ischemia - therapy; Cardiovascular; Cerebral Angiography - methods; Echocardiography, Transesophageal; Edoxaban; Factor Xa Inhibitors - therapeutic use; Female; Humans; left atrial appendage thrombus; Magnetic Resonance Angiography; Male; Middle Aged; Neurology; Pyridines - therapeutic use; resolution; Stroke - diagnostic imaging; Stroke - etiology; Stroke - therapy; Thiazoles - therapeutic use; Thrombectomy; Thrombosis - diagnosis; Thrombosis - drug therapy; Thrombosis - etiology; Time Factors; Treatment Outcome; atrial fibrillation; Edoxaban; resolution; left atrial appendage thrombus
• ISSN: 1052-3057; 1532-8511
• DOI: 10.1016/j.jstrokecerebrovasdis.2016.07.036

Here we report first 2 cases of patients with nonvalvular atrial fibrillation with acute cardioembolic stroke in whom thrombi in the left atrial appendage (LAA) were resolved by edoxaban administration. Case 1 reports an 86-year-old woman who suddenly showed right hemiparesis and aphasia due to occlusion of the left middle cerebral artery. She received mechanical thrombectomy and recovered neurologically. Transesophageal echocardiography (TEE) performed on day 1 demonstrated thrombus in the LAA. The thrombus was resolved on day 13 after initiation of edoxaban (30 mg once daily) instead of warfarin, which was administered before stroke onset. Case 2 reports a 49-year-old man who was admitted because of the sudden onset of left hemiparesis and aphasia. TEE demonstrated thrombus in the LAA on day 4, and edoxaban therapy (60 mg once daily) was initiated. The thrombus resolution was observed on day 16, and no embolic stroke occurred.