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Thrombus formation in left atrium on dabigatran therapy

Priyank Shah1, Priyam Mithawala2, Donna Konlian1

  • 1St. Joseph's Regional Medical Center, 703 Main Street, Paterson, NJ 07503, USA.

Case Reports in Cardiology
|March 21, 2015
PubMed

Insights

Dabigatran, a direct thrombin inhibitor, failed to prevent left atrial thrombus formation and embolic strokes in a patient with atrial fibrillation. This rare case highlights potential mechanisms of dabigatran failure in specific clinical scenarios.

Area of Science:

  • Cardiology
  • Pharmacology

Background:

  • Dabigatran is a direct thrombin inhibitor used for stroke prevention in nonvalvular atrial fibrillation.
  • It has shown efficacy in resolving left atrial thrombus.
  • Left atrial thrombus formation during dabigatran therapy is rare.

Purpose of the Study:

  • To report a rare case of left atrial thrombus formation and multiple embolic strokes in a patient treated with dabigatran.
  • To explore potential mechanisms underlying dabigatran failure in this context.

Main Methods:

  • Case report of a patient with chronic atrial fibrillation on dabigatran 150 mg twice daily.
  • Clinical presentation with multiple embolic strokes and confirmed left atrial thrombus.

Main Results:

  • The patient developed a left atrial thrombus despite therapeutic dabigatran dosing.
  • Multiple embolic strokes occurred, indicating treatment failure.
  • This represents one of only four reported cases globally.

Conclusions:

  • Dabigatran therapy can fail to prevent left atrial thrombus and thromboembolism in some patients.
  • Potential mechanisms include compensatory coagulation factor increases, incomplete thrombin inhibition, and lack of routine monitoring for adherence.
  • Further research into monitoring and alternative anticoagulation strategies may be warranted.

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