Treatment failure of low molecular weight heparin bridging therapy before a cardiac surgery intervention in a patient with atrial fibrillation

Atrial fibrillation and thrombophilia. DOAC as a valid alternative? A clinical case

“…[20][21][22][23] The choice of intravenous heparin, even if was not successful, was considered appropriate because the patient developed a thrombus despite ther- apy with warfarin, needing for optimal anticoagulation control and because in literature there are several cases of low molecular weight heparin failure. [15][16][17][18] DOAC are often preferred to other anticoagulants because they show rapid onset and offset of action, fewer drug interactions and dietary restriction; in addiction, their predictable anticoagulant effects allow to administrate fi xed doses without requirement of routine coagulation monitoring. 25,26 These favourable characteristics, simplifying treatment, improve adherence to therapy.…”

“…A diagnosis of heterozygous factor V of Leiden was made. [15][16][17][18][19][20][21][22][23] After 1 week of treatment, we performed another TEE, which showed persistence of the thrombotic mass in the LAA (Fig. 2B).…”

Imaging Modality to Guide Left Atrial Appendage Closure: Current Status and Future Perspectives

“…It is widely accepted the concept that the left atrial appendage (LAA) represents the most likely site of thrombus formation in NVAF patients [3,[12][13][14][15][16][17][18]. Indeed, a meta-analysis by Mahajan et al demonstrated that 89% of thrombi in the left atrium (LA) were located in the LAA [19], and Blackshear et al demonstrated that thrombus was present in about 17% of patients with non-valvular AF and of these, in 91% of cases it was localized in LAA [20].…”