Rivaroxaban bests warfarin for left atrial/left atrial appendage thrombosis in Afib

  • Ke HH & al.
  • J Thromb Thrombolysis
  • 5 Jun 2019

  • International Clinical Digest
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  • Rivaroxaban (e.g., Xarelto) outperforms warfarin in resolving left atrial/left atrial appendage (LA/LAA) thrombus in patients with nonvalvular Afib, especially after 6 weeks of treatment.

Why this matters

  • Afib-induced LA/LAA thrombus development is the major source of pulmonary embolism and increases risk for other thromboembolic events.
  • Vitamin K antagonists (e.g., warfarin) are effective in preventing stroke in these patients but require continual monitoring and dose adjustments.

Key results

  • With rivaroxaban: thrombin time (P<.0001 plasma prothrombin time and activated partial thromboplastin were significantly lower fibrinogen higher.>
  • Also with rivaroxaban: transesophageal echocardiography showed average thrombus length (P<.0001 width and area were significantly lower after weeks of treatment.>
  • No major or fatal bleeding, ischemic stroke in either group.

Study design

  • Single-center randomized, controlled study from prospectively collected registry of patients with nonvalvular Afib (n=80) with LA/LAA thrombus.
  • Participants were randomly allocated to rivaroxaban 20 mg/day for 12 weeks or warfarin (international normalized ratio, 2-3).
  • Outcome: thrombus dissolution following treatment for 3 months, Afib-related stroke/embolism.
  • Funding: Natural Science Foundation of Guangxi Province of China, others.


  • Single-center study.
  • No serological marker to assess function of dissolving thrombosis.
  • Relatively small left atrial volumes.

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