Giant thrombosis in right atrium resulting from poor adherence to DOAC: a case report

Abstract

　We experienced the rare case of removal of a giant thrombosis in the right atrium caused by low adherence to direct oral anticoagulant (DOAC) in a patient also diagnosed postoperatively with antiphospholipid syndrome. The patient was first diagnosed with deep vein thrombosis (DVT) and was therefore prescribed a DOAC; however, treatment was self-discontinued owing to decreased DVT symptoms but mainly because of the price of the drug. DOACs, adopted since 2011 in Japan, carry advantages such as no food restriction, fewer brain-bleeding complications, and no need for coagulation monitoring. The main drawback of DOACs, however, is the price, some 20-30 times more expensive than warfarin, often motivating patients to lower their adherence which sometimes leads to severe complications, such as thrombosis as in this case.