Massive Left Atrial Thrombus in a Patient With Rheumatic Mitral Stenosis and Atrial Fibrillation While Anticoagulated With Dabigatran

Luis, Sushil Allen; Poon, K.; Luis, Chris R.; Shukla, Akhil; Bett, Nicholas; Hamilton-Craig, Christian

doi:10.1161/circimaging.113.000253

Cited by 21 publications

(15 citation statements)

References 4 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Although Dabi appears to be an effective alternative to warfarin in preventing stroke or systemic embolism without requiring PT–INR monitoring, the fact that 4% of patients receiving Dabi still had LA thrombus in our survey suggests that TEE is useful when performed before elective ECV of persistent AF. Thrombus may develop even under Dabi treatment in the presence of mechanical heart valves or rheumatic mitral stenosis [12,13], but a few cases of failure to prevent LA thrombus formation with the use of this agent have also been reported in patients with AF without such backgrounds [14–16]. Although it is hard to prove, we speculate that not only higher CHADS 2 scores, but also the insufficient Dabi dosage given to some of our patients might have led to inadequate anticoagulation and subsequent clot formation.…”

Section: Discussionmentioning

confidence: 77%

Left atrial thrombus formation and resolution during dabigatran therapy: A Japanese Heart Rhythm Society report

Mitamura

Nagai

Watanabe

et al. 2015

Journal of Arrhythmia

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 77%

Left atrial thrombus formation and resolution during dabigatran therapy: A Japanese Heart Rhythm Society report

Mitamura

Nagai

Watanabe

et al. 2015

Journal of Arrhythmia

View full text Add to dashboard Cite

show abstract

“…Despite the theoretical differences in the pathophysiological characteristics of thrombosis between patients with and without valvular AF, cases of left atrial thrombosis in severe rheumatic mitral stenosis, despite treatment with dabigatran, have been reported. 30 In our study, we did not exclude patients with rheumatic valvular disease, and we believe it may be unsafe to extrapolate our findings to the group of patients with hemodynamically significant rheumatic valvular disease, who represent a minority of our patient population.…”

Section: Discussionmentioning

confidence: 97%

Safety and Efficacy of Novel Oral Anticoagulants Versus Warfarin in Medicare Beneficiaries With Atrial Fibrillation and Valvular Heart Disease

Briasoulis

Inampudi

Akintoye

et al. 2018

JAHA

View full text Add to dashboard Cite

BackgroundWe examined a large community‐based sample of patients with atrial fibrillation (AF) and valvular heart disease (VHD) (excluding prosthetic valves) with a goal to compare outcomes among patients with AF, with and without VHD, taking warfarin, dabigatran, and rivaroxaban.Methods and ResultsWe identified Medicare beneficiaries enrolled in Medicare Part D benefit plan from 2011 to 2013 with newly diagnosed AF (18 137 patients with VHD [dabigatran, 1979; rivaroxaban, 2027; warfarin, 14 131] and 85 596 patients without VHD [dabigatran, 13 522; rivaroxaban, 14 257; warfarin, 57 817]). Primary outcomes of all‐cause mortality, ischemic strokes, major bleeding, and myocardial infarction were compared across the 3 anticoagulants using 3‐way propensity‐matched samples. After propensity matching, a total of 5871 patients with VHD and 40 221 patients without VHD and AF were studied. Both dabigatran and rivaroxaban were associated with significantly lower risk of death in patients with VHD with AF (dabigatran versus warfarin: hazard ratio, 0.71; 95% confidence interval, 0.52–0.98; P=0.038; rivaroxaban versus warfarin: hazard ratio, 0.68; 95% confidence interval, 0.49–0.95; P=0.022). Nongastrointestinal bleeding was significantly reduced with dabigatran and rivaroxaban versus warfarin in those with VHD (dabigatran versus warfarin: hazard ratio, 0.17; 95% confidence interval, 0.06–0.49; P=0.001; rivaroxaban versus warfarin: hazard ratio, 0.37; 95% confidence interval, 0.17–0.84; P=0.017). Ischemic stroke and gastrointestinal bleeding rates did not differ between rivaroxaban, dabigatran, and warfarin in patients with VHD. The effects of the 3 anticoagulants on outcomes were comparable in patients with and without VHD and with AF.ConclusionsIn this cohort of Medicare beneficiaries with VHD (excluding patients with prosthetic valves) and new‐onset AF between 2011 and 2013, novel oral non–vitamin K anticoagulants were safe and effective options for prevention of systemic thromboembolism.

show abstract

“…It has also been used in patients with atrial fibrillation who had documented left atrial thrombus, proving its role in resolution of thrombus [ 4 , 5 ]. However, left atrial thrombus formation on dabigatran therapy as in our case has been reported in 3 other cases in the literature till date [ 6 , 7 ]. Sharma et al [ 6 ] recently reported two cases of left atrial thrombus formation on dabigatran therapy for chronic atrial fibrillation.…”

Section: Discussionmentioning

confidence: 70%

Thrombus Formation in Left Atrium on Dabigatran Therapy

Shah

Mithawala

Konlian

et al. 2015

Case Reports in Cardiology

View full text Add to dashboard Cite

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.

show abstract

Massive Left Atrial Thrombus in a Patient With Rheumatic Mitral Stenosis and Atrial Fibrillation While Anticoagulated With Dabigatran

Abstract: The online-only Data Supplement is available at http://circimaging.ahajournals.org/lookup/suppl

Cited by 21 publications

References 4 publications

Left atrial thrombus formation and resolution during dabigatran therapy: A Japanese Heart Rhythm Society report

Left atrial thrombus formation and resolution during dabigatran therapy: A Japanese Heart Rhythm Society report

Safety and Efficacy of Novel Oral Anticoagulants Versus Warfarin in Medicare Beneficiaries With Atrial Fibrillation and Valvular Heart Disease

Thrombus Formation in Left Atrium on Dabigatran Therapy

Contact Info

Product

Resources

About