CASE REPORTS   

Gazzetta Medica Italiana Archivio per le Scienze Mediche 2015 April;174(4):185-7

Copyright © 2015 EDIZIONI MINERVA MEDICA

language: English

Successful resolution of a giant ICD lead thrombus under rivaroxaban treatment

Kypta A. ¹, Blessberger H. ¹, Kammler J. ¹, Saleh K. ¹, Berg J. ², Hönig S. ², Steinwender C. ¹

¹ Cardiovascular Division, General and University Teaching Hospital Linz, Linz, Austria; ² Laboratory of Medicine, General and University Teaching Hospital Linz, Linz, Austria

A 47-year old women the patient exhibited atypical chest pain. She had a history of resuscitation due to torsade de pointes tachycardia caused by a long QT-syndrome. Therefore, a single chamber ICD had been implanted. There were no clinical signs of systemic infection such as fever or abnormal fatigue. Echocardiography showed a very large walnut shaped mass (>4 cm) attached to ICD lead. All laboratory parameters, such as inflammation markers and platelet count as well as the patient’s protein C, protein S and antithrombin III levels, were found within normal ranges. Genetic thrombophilia testing was also negative. Despite these negative findings, a hypercoagulabile state could be demonstrated with thrombelastography. After three weeks of rivaroxaban treatment TEE showed a significant decrease of thrombus size. Subsequently, complete resolution of the thrombus was observed after 12 weeks of continuous treatment with rivaroxaban. Importantly, there was no need for lead extraction in the course of the disease. The patient is still on rivaroxaban and in a good clinical condition up to now. This case report highlights an unusual pathology with an extensive thrombotic mass attached to an ICD lead that disappeared completely under treatment with a new oral factor-Xa inhibitor.