Saito Shin, Tomita Hirofumi, Kimura Yoshihiro, Shiroto Hiroshi, Hagii Joji, Metoki Norifumi, Hitomi Hiroyasu, Kamada Takaatsu, Osanai Tomohiro, Okumura Ken, Yasujima Minoru
Hirosaki Stroke and Rehabilitation Center, Hirosaki, Japan.
Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
J Stroke Cerebrovasc Dis. 2014 Jul;23(6):1747-9. doi: 10.1016/j.jstrokecerebrovasdis.2014.01.014. Epub 2014 Apr 13.
We report a case of a nonvalvular atrial fibrillation (NVAF) patient with acute cardioembolic stroke in whom rivaroxaban, an oral direct factor Xa inhibitor, reduced a smoke-like echo in the left atrium and resolved a thrombus in the left atrial appendage. A 71-year-old man was admitted because of the sudden onset of right hemiplegia and aphasia and was diagnosed with acute cardioembolic stroke associated with NVAF. The patient had not been treated with warfarin before admission, and rivaroxaban therapy (15 mg once daily) was initiated. Transesophageal echocardiography was performed on day 8 and a mobile thrombus was found in the left atrial appendage, accompanied by a remarkable smoke-like echo in the left atrium. Notably, the thrombus was resolved and the smoke-like echo was reduced on day 40. No recurrent ischemic stroke occurred. We describe favorable effects of rivaroxaban on the reduction of a smoke-like echo and on the resolution of a thrombus in the left atrium in an NVAF patient with acute cardioembolic stroke.
我们报告了一例非瓣膜性心房颤动（NVAF）合并急性心源性脑栓塞的患者，口服直接Xa因子抑制剂利伐沙班减少了左心房内类似烟雾状的回声，并使左心耳内的血栓溶解。一名71岁男性因突发右侧偏瘫和失语入院，被诊断为与NVAF相关的急性心源性脑栓塞。该患者入院前未接受华法林治疗，遂开始利伐沙班治疗（每日一次，每次15mg）。在第8天进行了经食管超声心动图检查，发现左心耳内有活动血栓，同时左心房内有明显的类似烟雾状的回声。值得注意的是，在第40天时血栓溶解，类似烟雾状的回声减少。未发生复发性缺血性卒中。我们描述了利伐沙班对NVAF合并急性心源性脑栓塞患者左心房内类似烟雾状回声的减少以及血栓溶解的良好效果。
