Mechanical Aortic Valve Thrombosis During Anticoagulation Using Oral Rivaroxaban: A Case Report

TL;DR

A patient with a mechanical aortic valve developed a dangerous blood clot after switching from warfarin to rivaroxaban, highlighting the risks of using DOACs in this population.

Contribution

This case report demonstrates the potential dangers of using rivaroxaban in patients with mechanical heart valves, emphasizing the need to follow established protocols with warfarin.

Findings

A patient with a mechanical aortic valve developed a thrombus after switching to rivaroxaban.

The patient required urgent valve replacement due to the clot.

The case underscores the risks of using DOACs in mechanical valve patients.

Abstract

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.

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