Comparative Study of Rivaroxaban and Warfarin for Treating the Patients With Left Ventricular Thrombus / 中国循环杂志

Objective: To compare the safety and efifcacy of rivaroxaban and warfarin for treating the patients with left ventricular thrombus. Methods: A total of 31 patients with left ventricular thrombus were studied, the patients were randomly divided into 2 groups:Warfarin group, n=16, the patients initially received oral warfarin and low molecular weight heparin at (2.5-3) mg/day, when the INR value reached 2.0-3.0, heparin was stopped and warfarin was continued, the INR value was monitored every 3 days for 3 times, when INR value was stably kept at 2.0-3.0, it was then monitored for every 2 weeks. Rivaroxaban group,n=15, the patients received oral rivaroxaban at 10 mg twice a day. All patients were followed-up for 3 months, the thrombus remission time, new onset of thrombosis, embolism and bleeding events during treatment period were compared between 2 groups. Results: The patients’ age, gender, complication, size of thrombus and medication were similar between 2 groups. Compared with Warfarin group, Rivaroxaban group had the shorter thrombus remission time, (60.00±5.50)d vs (71.00±8.50) d,P0.05. Conclusion: Rivaroxaban had better effect than warfarin for treating the patients with left ventricular thrombus without increasing the risk of bleeding.

Cecal Intramural Hematoma after Acupuncture in a Patient Taking Anticoagulant Drug

The most common causes of an intramural hematoma of the bowel are blunt trauma and complications from an anticoagulant drug. The duodenum is the most common site of an intramural hematoma caused by blunt trauma. An intramural hematoma caused by the use of an anticoagulant drug commonly involves the small bowel and can be conservatively treated with good prognosis. However, an intramural hematoma caused by trauma or injury in a patient who is taking an anticogulant drug has rarely been reported. We report the case of 75-year-old woman with an intramural hematoma who took cumadin after acupuncture and who presented with acute abdominal pain, especially on the RLQ area. Abdominal CT showed a cecal wall enlargment and enhancement. We performed an emergency operation under the impression of peritonitis. During the opertion, we found the cecal intramural hematoma, so a right hemicolectomy was done. An Intramural hematoma after a focal injury, such as acupuncture, in a patient who is taking an anticoagulant drug can take place in Korea. We think that proper treatment should be studied. Also education patients taking an anticoagulant drug should be addressed.