Dabigatran Therapy Resulting in the Resolution of Rivaroxaban-resistant Left Atrial Appendage Thrombi in Patients with Atrial Fibrillation

Intern Med. 2017;56(15):1977-1980. doi: 10.2169/internalmedicine.56.8508. Epub 2017 Aug 1.


Patients with persistent atrial fibrillation (AF) and a large left atrium are at a high risk for thromboembolisms. Recently, direct oral anticoagulants (DOACs) have mainly been used for the prevention of cardiac embolisms caused by AF. Transesophageal echocardiography (TEE) is performed in order to exclude any left atrial appendage (LAA) thrombi. We herein report two cases of persistent AF, both of which were treated with rivaroxaban for more than two years. Since TEE identified mobile LAA thrombi with this treatment, we switched from rivaroxaban to the direct thrombin inhibitor dabigatran. Dabigatran resolved the LAA thrombi that had been refractory to rivaroxaban.

Keywords: atrial fibrillation; direct oral anticoagulants; thromboembolism.

MeSH terms

  • Aged
  • Antithrombins / therapeutic use*
  • Atrial Appendage / diagnostic imaging
  • Atrial Fibrillation / drug therapy*
  • Dabigatran / therapeutic use*
  • Echocardiography, Transesophageal
  • Heart Atria / diagnostic imaging
  • Humans
  • Male
  • Rivaroxaban / therapeutic use*
  • Thrombosis / drug therapy*


  • Antithrombins
  • Rivaroxaban
  • Dabigatran