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Chagas disease leads to congestive heart failure, apical aneurysm, and may cause stroke or systemic embolism for intraventricular thrombus. We present a case of a 61-year-old man admitted for stroke 5 months after a renal embolism. An intraventricular thrombus was observed, probably the source of the cerebral and renal embolisms. The patient refused warfarin and rivaroxaban was used instead. After 40 days of treatment the thrombus had dissolved, after 20 months of regular use of rivaroxaban no more embolic events were observed. The use of rivaroxaban was effective in preventing embolic events in Chagas disease and intraventricular thrombus. < Learning objective: Warfarin is recommended for stroke prevention in patients with Chagas disease and left ventricular dysfunction or apical aneurysm, even in the absence of thrombus. None of the new oral anticoagulants is recommended in this context. Rivaroxaban was safe and effective in preventing embolic events in a patient with Chagas disease and a ventricular thrombus.> [ABSTRACT FROM AUTHOR]