Bioprosthetic aortic valve thrombosis under effective direct oral anticoagulant therapy

Echocardiography. 2023 Sep;40(9):983-988. doi: 10.1111/echo.15642. Epub 2023 Jun 26.


With the increase in transcatheter procedures, the use of bioprosthetic valves has become more frequent in clinical practice. However, the optimal antithrombotic management of patients with bioprosthetic valves remains controversial. In this case report, we describe a patient with a bioprosthetic aortic valve who developed a thrombus while receiving effective dose direct oral anticoagulant (DOAC) therapy. A 73-year-old male patient with a bioprosthetic aortic valve replacement 2 years prior presented with a mobile thrombus and early degeneration of the valve, detected during routine follow-up while being treated with apixaban. Although the valve thrombus regressed after switching to a different anticoagulant drug, we observed that the decreased but still high gradient persisted due to the early degeneration. Anticoagulant management of bioprosthetic valve patients demands careful attention. Although evidence supporting the use of DOACs is growing, close patient follow-up and further evaluation in case of doubt remain critical. The development of a thrombus in a bioprosthetic valve patient who is receiving anticoagulation therapy, as in this case, highlights the need for optimal management to prevent thromboembolic complications and valve degeneration.

Keywords: DOAC; bioprosthetic aortic valve; valve thrombosis.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Anticoagulants / therapeutic use
  • Aortic Valve / diagnostic imaging
  • Aortic Valve / surgery
  • Bioprosthesis* / adverse effects
  • Heart Valve Prosthesis* / adverse effects
  • Humans
  • Male
  • Thromboembolism* / complications
  • Thrombosis* / drug therapy
  • Thrombosis* / etiology
  • Thrombosis* / prevention & control


  • Anticoagulants