Left ventricular thrombi are mostly seen in the akinetic segments of left ventricle and warfarin is the golden standard treatment. In our case, a 67-year-old male patient with ischemic dilated cardiomyopathy and atrial fibrillation was under warfarin treatment, but due to fluctuations in international normalized ratio, warfarin was discontinued and changed to rivaroxaban (20 mg once a day). He had a fixed thrombus measuring 1.80 x 1.12 cm(2) in the left ventricle under warfarin treatment before rivaroxaban use. After 6 months of rivaroxaban treatment, the thrombus regressed to 1.54 x 1.06 cm(2) without any embolic episode or bleeding. This case supports the finding that rivaroxaban can be a safe alternative to warfarin when warfarin cannot be used.