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Left atrial appendage thrombus on full-dose dabigatran treatment: a case report.
Eur Heart J Case Rep. 2020 Jun; 4(3):1-4.EH

Abstract

Background

Dabigatran is a direct competitive thrombin inhibitor approved for stroke prevention in non-valvular atrial fibrillation. At full-dose, dabigatran showed similar rates of bleedings and higher efficacy compared to warfarin.

Case summary

We report a case of acute ischaemic stroke in a patient treated with dabigatran 150 mg b.i.d. for atrial fibrillation. After an off-label treatment with idarucizumab, a humanized monoclonal antibody approved for dabigatran reversal, we performed a successful intravenous thrombolysis (IVT). Transoesophageal echocardiography showed a left atrial appendage (LAA) thrombus, despite full-dose dabigatran and an adequate therapy adherence.

Discussion

There are few cases of LAA thrombus during dabigatran treatment reported in literature till date. We analyse the possible pathogenetic mechanisms involved in dabigatran failure, including drug interactions and unexpected genetic variations interfering with dabigatran serum levels suggesting periodical assessment of direct Oral Anticoagulant levels. Furthermore, we confirm initial reports of safety and efficacy of intravenous thrombolysis after idarucizumab, in case of dabigatran failure.

Authors+Show Affiliations

Division of Neurology and Stroke Unit, AORN Cardarelli, Via Antonio Cardarelli 9, 80128 Naples, Italy.Emergency Room and Observation Unit, AORN Cardarelli, Via Antonio Cardarelli 9, 80128 Naples, Italy.Division of Neurology and Stroke Unit, AORN Cardarelli, Via Antonio Cardarelli 9, 80128 Naples, Italy.Division of Cardiology and Coronary Care Unit, AORN Cardarelli, Via Antonio Cardarelli 9, 80128 Naples, Italy.

Pub Type(s)

Case Reports

Language

eng

PubMed ID

32617467

Citation

Candelaresi, Paolo, et al. "Left Atrial Appendage Thrombus On Full-dose Dabigatran Treatment: a Case Report." European Heart Journal. Case Reports, vol. 4, no. 3, 2020, pp. 1-4.
Candelaresi P, Iannuzzi A, Servillo G, et al. Left atrial appendage thrombus on full-dose dabigatran treatment: a case report. Eur Heart J Case Rep. 2020;4(3):1-4.
Candelaresi, P., Iannuzzi, A., Servillo, G., & Gottilla, R. (2020). Left atrial appendage thrombus on full-dose dabigatran treatment: a case report. European Heart Journal. Case Reports, 4(3), 1-4. https://doi.org/10.1093/ehjcr/ytaa057
Candelaresi P, et al. Left Atrial Appendage Thrombus On Full-dose Dabigatran Treatment: a Case Report. Eur Heart J Case Rep. 2020;4(3):1-4. PubMed PMID: 32617467.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Left atrial appendage thrombus on full-dose dabigatran treatment: a case report. AU - Candelaresi,Paolo, AU - Iannuzzi,Angela, AU - Servillo,Giovanna, AU - Gottilla,Rossella, Y1 - 2020/04/24/ PY - 2019/10/03/received PY - 2019/11/11/revised PY - 2020/02/14/accepted PY - 2020/7/4/entrez PY - 2020/7/4/pubmed PY - 2020/7/4/medline KW - Atrial fibrillation KW - Case report KW - Dabigatran KW - Idarucizumab KW - Intravenous thrombolysis KW - Left atrial appendage thrombus SP - 1 EP - 4 JF - European heart journal. Case reports JO - Eur Heart J Case Rep VL - 4 IS - 3 N2 - Background: Dabigatran is a direct competitive thrombin inhibitor approved for stroke prevention in non-valvular atrial fibrillation. At full-dose, dabigatran showed similar rates of bleedings and higher efficacy compared to warfarin. Case summary: We report a case of acute ischaemic stroke in a patient treated with dabigatran 150 mg b.i.d. for atrial fibrillation. After an off-label treatment with idarucizumab, a humanized monoclonal antibody approved for dabigatran reversal, we performed a successful intravenous thrombolysis (IVT). Transoesophageal echocardiography showed a left atrial appendage (LAA) thrombus, despite full-dose dabigatran and an adequate therapy adherence. Discussion: There are few cases of LAA thrombus during dabigatran treatment reported in literature till date. We analyse the possible pathogenetic mechanisms involved in dabigatran failure, including drug interactions and unexpected genetic variations interfering with dabigatran serum levels suggesting periodical assessment of direct Oral Anticoagulant levels. Furthermore, we confirm initial reports of safety and efficacy of intravenous thrombolysis after idarucizumab, in case of dabigatran failure. SN - 2514-2119 UR - https://www.unboundmedicine.com/medline/citation/32617467/Left_atrial_appendage_thrombus_on_full-dose_dabigatran_treatment:_a_case_report DB - PRIME DP - Unbound Medicine ER -
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