[Splenic infarction after warfarin discontinuation during atrial fibrillation]

Area of Science:

• Cardiology
• Radiology
• Internal Medicine

Background:

• Splenic infarction is a rare condition often associated with embolic events.
• Atrial fibrillation is a common arrhythmia and a significant risk factor for systemic embolism.
• Dilated cardiomyopathy and mechanical prosthetic valves increase the risk of thromboembolic complications.

Observation:

• A patient with dilated cardiomyopathy and a mechanical prosthetic valve presented with sudden abdominal pain and fever after discontinuing anticoagulant therapy for atrial fibrillation.
• Diagnostic imaging, including enhanced-contrast computed tomography, confirmed splenic infarction.
• Ultrasound and radiography were insufficient for diagnosis.

Findings:

• Splenic infarction was diagnosed in a patient with atrial fibrillation and a mechanical prosthetic valve.
• Discontinuation of anticoagulant therapy was a potential trigger for the splenic infarction.
• Re-initiation of anticoagulant therapy resulted in rapid clinical improvement.

Implications:

• Splenic infarction should be considered in patients presenting with left hypochondrium pain, particularly those with risk factors like atrial fibrillation or prosthetic valves.
• Anticoagulant therapy remains the gold standard for treating embolic splenic infarction.
• Early diagnosis and treatment are crucial for favorable patient outcomes.