• Huan Sun, Qini Zhao, Yanjing Wang, Robert Lakin, Xueyan Liu, Ming Yu, Hongliang Yang, Dongmei Gao, Weiwei Chen, Guangyuan Gao, Mengjie Yan, Yuquan He, and Ping Yang.
• Cardiology Department, China-Japan Union Hospital of Jilin University.
• Medicine (Baltimore). 2018 Dec 1; 97 (51): e13623.

RationaleAnti-thrombosis therapy for atrial fibrillation (AF) management and stroke prevention is an important aspect of disease management. Novel oral anticoagulants (NOACs) are recommended by guidelines for AF management. However, if one can switch one NOAC to another when the former showed a poor effect has not been fully determined.Patient ConcernsA 52-year-old man was admitted to our center for heart failure and AF with a thrombus in the left atrium.DiagnosesCardiomyopathy was diagnosed by cardiac magnetic resonance (CMR) and echocardiography.InterventionsHe was prescribed rivaroxaban (20 mg daily) as treatment, and dabigatran (150 mg twice daily) was used when the thrombus was found to be non-response to rivaroxaban.OutcomesThe rivaroxaban did not diminish the atrial thrombus, and dabigatran was given instead which finally eliminated the thrombus.LessonsIndividualized responsiveness to NOACs should be considered and paid more attention to during clinical practice.

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