Kinoshita Ryoji, Watanabe Taiju, Matsumoto Ryumon, Hirooka Kazunobu
Cardiovascular Surgery, Tsuchiura Kyodo General Hospital, Tsuchiura, JPN.
Cureus. 2024 Jul 20;16(7):e65007. doi: 10.7759/cureus.65007. eCollection 2024 Jul.
Direct oral anticoagulants (DOACs) are widely used in cardiovascular medicine. Although rivaroxaban has potential benefits for anticoagulation in certain contexts, DOACs remain contraindicated in patients with mechanical heart valves. This case report highlights the life-threatening risks of rivaroxaban use in patients with mechanical aortic valves, underscoring the lack of proven efficacy and the necessity of adhering to established anticoagulation protocols with warfarin for this patient population. Here, we report a case of a 65-year-old man who had previously undergone aortic valve replacement and developed a thrombus in the mechanical aortic valve six months after switching from warfarin to rivaroxaban. The patient experienced a sudden loss of consciousness and chest discomfort. Echocardiography revealed a thrombus in the valve requiring urgent reoperation and replacement with a bioprosthetic valve. The postoperative recovery was uneventful.
直接口服抗凝剂（DOACs）在心血管医学中被广泛使用。尽管利伐沙班在某些情况下具有抗凝的潜在益处，但机械心脏瓣膜患者仍禁用DOACs。本病例报告强调了在机械主动脉瓣患者中使用利伐沙班的危及生命的风险，突出了其缺乏已证实的疗效以及对于该患者群体遵循华法林既定抗凝方案的必要性。在此，我们报告一例65岁男性患者，该患者此前接受了主动脉瓣置换术，在从华法林转换为利伐沙班六个月后，机械主动脉瓣出现血栓形成。患者突然意识丧失并伴有胸部不适。超声心动图显示瓣膜有血栓，需要紧急再次手术并用生物瓣膜进行置换。术后恢复顺利。
