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Related Experiment Video

Updated: May 21, 2026

The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation

The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation

Published on: February 28, 2012

Dabigatran and left atrial appendage thrombus.

Alejandro Vidal¹, Gabriel Vanerio

¹CASMU Arrhythmia Service, Montevideo, Uruguay. alevidalmargenat@gmail.com

Journal of Thrombosis and Thrombolysis

|May 31, 2012

Summary

This case study shows successful resolution of a large left atrial appendage thrombus using dabigatran after warfarin failure. Electrical cardioversion was then safely performed in a patient with atrial fibrillation.

Area of Science:

Cardiology
Internal Medicine

Background:

Atrial fibrillation is a common arrhythmia associated with an increased risk of thromboembolism.
Left atrial appendage thrombus formation is a significant complication, necessitating effective anticoagulation strategies.

Observation:

A 59-year-old woman with arterial hypertension presented with palpitations and newly diagnosed atrial fibrillation.
A trans-esophageal echocardiogram revealed a large left atrial appendage thrombus.
Initial anticoagulation with warfarin failed to achieve therapeutic international normalized ratios (INRs).

Findings:

The patient was switched to dabigatran, a direct oral anticoagulant.
Dabigatran therapy led to successful resolution of the left atrial appendage thrombus.
The patient subsequently underwent successful electrical cardioversion.

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Implications:

This case highlights dabigatran as a viable alternative for patients with atrial fibrillation and left atrial thrombus when warfarin is ineffective.
Early thrombus resolution with direct oral anticoagulants may facilitate successful cardioversion.
Understanding the natural history and management of left atrial thrombus is crucial for preventing stroke in atrial fibrillation patients.