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Thrombus formation in left atrium on dabigatran therapy.

Shah P, Mithawala P, Konlian D, Soyombo A, Bikkina M - Case Rep Cardiol (2015)

Bottom Line: The patient presented with multiple embolic strokes.There are only three such cases reported in the literature till date, all of whom had thrombus in the left atrium.The possible mechanisms of dabigatran failure include compensatory increase in upstream coagulation factors due to single level downstream blockade of thrombin, lack of inhibition of all available thrombin, and lack of monitoring measures that can be implemented in common clinical laboratories that lead to failure to assess adherence, which in turn can lead to dabigatran failure.

View Article: PubMed Central - PubMed

Affiliation: St. Joseph's Regional Medical Center, 703 Main Street, Paterson, NJ 07503, USA.

ABSTRACT
Dabigatran is a direct thrombin inhibitor, approved in the United States for stroke prevention in nonvalvular atrial fibrillation and prevention and treatment of thromboembolism. It has been also used in patients with documented left atrial thrombus, where treatment with dabigatran effectively led to thrombus resolution. We present a rare case of left atrial thrombus formation in a patient with chronic atrial fibrillation being treated with dabigatran 150 mg twice a day. The patient presented with multiple embolic strokes. There are only three such cases reported in the literature till date, all of whom had thrombus in the left atrium. The possible mechanisms of dabigatran failure include compensatory increase in upstream coagulation factors due to single level downstream blockade of thrombin, lack of inhibition of all available thrombin, and lack of monitoring measures that can be implemented in common clinical laboratories that lead to failure to assess adherence, which in turn can lead to dabigatran failure.

No MeSH data available.


Related in: MedlinePlus

Transesophageal echocardiogram showing a thrombus in the left atrium (arrow). LA: left atrium, LV: left ventricle, and AA: ascending aorta.
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fig1: Transesophageal echocardiogram showing a thrombus in the left atrium (arrow). LA: left atrium, LV: left ventricle, and AA: ascending aorta.

Mentions: A transesophageal echocardiogram was done on this admission to evaluate a likely embolic source of acute stroke. Surprisingly, it revealed significant smoke and a mobile thrombus in the left atrium measuring about 0.6 cm × 0.3 cm (Figure 1, Video 1 (see Video 1 in Supplementary Material available online at http://dx.doi.org/10.1155/2015/518982)). The left atrial appendage was free of thrombus. The patient was switched to warfarin anticoagulation for presumed dabigatran failure. The rest of his hospital course was unremarkable and he was discharged to acute rehabilitation after 3 days on warfarin anticoagulation along with low molecular weight heparin bridging.


Thrombus formation in left atrium on dabigatran therapy.

Shah P, Mithawala P, Konlian D, Soyombo A, Bikkina M - Case Rep Cardiol (2015)

Transesophageal echocardiogram showing a thrombus in the left atrium (arrow). LA: left atrium, LV: left ventricle, and AA: ascending aorta.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4352418&req=5

fig1: Transesophageal echocardiogram showing a thrombus in the left atrium (arrow). LA: left atrium, LV: left ventricle, and AA: ascending aorta.
Mentions: A transesophageal echocardiogram was done on this admission to evaluate a likely embolic source of acute stroke. Surprisingly, it revealed significant smoke and a mobile thrombus in the left atrium measuring about 0.6 cm × 0.3 cm (Figure 1, Video 1 (see Video 1 in Supplementary Material available online at http://dx.doi.org/10.1155/2015/518982)). The left atrial appendage was free of thrombus. The patient was switched to warfarin anticoagulation for presumed dabigatran failure. The rest of his hospital course was unremarkable and he was discharged to acute rehabilitation after 3 days on warfarin anticoagulation along with low molecular weight heparin bridging.

Bottom Line: The patient presented with multiple embolic strokes.There are only three such cases reported in the literature till date, all of whom had thrombus in the left atrium.The possible mechanisms of dabigatran failure include compensatory increase in upstream coagulation factors due to single level downstream blockade of thrombin, lack of inhibition of all available thrombin, and lack of monitoring measures that can be implemented in common clinical laboratories that lead to failure to assess adherence, which in turn can lead to dabigatran failure.

View Article: PubMed Central - PubMed

Affiliation: St. Joseph's Regional Medical Center, 703 Main Street, Paterson, NJ 07503, USA.

ABSTRACT
Dabigatran is a direct thrombin inhibitor, approved in the United States for stroke prevention in nonvalvular atrial fibrillation and prevention and treatment of thromboembolism. It has been also used in patients with documented left atrial thrombus, where treatment with dabigatran effectively led to thrombus resolution. We present a rare case of left atrial thrombus formation in a patient with chronic atrial fibrillation being treated with dabigatran 150 mg twice a day. The patient presented with multiple embolic strokes. There are only three such cases reported in the literature till date, all of whom had thrombus in the left atrium. The possible mechanisms of dabigatran failure include compensatory increase in upstream coagulation factors due to single level downstream blockade of thrombin, lack of inhibition of all available thrombin, and lack of monitoring measures that can be implemented in common clinical laboratories that lead to failure to assess adherence, which in turn can lead to dabigatran failure.

No MeSH data available.


Related in: MedlinePlus