# Rivaroxaban Failure Presenting With Renal Infarction in a Patient With Persistent Atrial Fibrillation: A Case Report

## TL;DR

A patient with atrial fibrillation on rivaroxaban experienced a rare case of anticoagulant failure leading to a renal infarction.

## Contribution

This case report highlights a rare instance of rivaroxaban failure resulting in left renal infarction.

## Key findings

- Rivaroxaban failure led to left renal infarction in a patient with atrial fibrillation.
- The patient had dense spontaneous echocardiographic contrast in the left atrium.
- DOAC failure is rare but can result in severe complications like renal infarction.

## Abstract

Direct oral anticoagulants (DOAC) are the preferred choice of anticoagulation for patients with atrial fibrillation. DOACs are always preferred over vitamin K antagonists due to their better safety profile in terms of life-threatening bleeding and decreased need for INR (international normalised ratio) monitoring. Although the most commonly used anticoagulation, failure to DOAC has been reported. Here we present a rare case of rivaroxaban failure presenting with left renal infarction in a patient who had dense spontaneous echocardiographic contrast in the left atrium visualised by transthoracic echocardiography.