Left ventricular mural thrombus despite treatment with dabigatran and clopidogrel.
Maise H FredgartSabine GillPublished in: BMJ case reports (2018)
We describe a case with severe heart failure and moderate aortic stenosis. Due to previous atrial fibrillation and ischaemic heart disease, this patient was treated with both dabigatran and clopidogrel. Despite this, a large mural thrombus was found on echocardiography. The treatment was altered to warfarin, but the thrombus did not resolve during the next eight months.Guidelines for the use of anticoagulant treatment in left ventricular thrombus are needed. Previously, a few cases presenting resistance to novel oral anticoagulants have been published and cases with thrombus formation due to dabigatran have been described. Our patient showed resistance to both dabigatran and warfarin, and there was no thrombus resolution when changing the treatment to warfarin.
Keyphrases
- atrial fibrillation
- oral anticoagulants
- left ventricular
- heart failure
- left atrial
- direct oral anticoagulants
- aortic stenosis
- percutaneous coronary intervention
- venous thromboembolism
- left atrial appendage
- catheter ablation
- case report
- acute myocardial infarction
- acute coronary syndrome
- systematic review
- hypertrophic cardiomyopathy
- aortic valve
- transcatheter aortic valve replacement
- cardiac resynchronization therapy
- coronary artery disease
- smoking cessation
- high intensity