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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
Summary
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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