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Left atrial thrombus under dabigatran in a patient with nonvalvular atrial fibrillation

A M Janssen1, D van de Kerkhof, B Szabó

  • 1Department of Internal Medicine, St.Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands.

The Netherlands Journal of Medicine
|August 31, 2016
PubMed

Insights

This case study highlights a patient experiencing thromboembolic events despite taking dabigatran, suggesting potential underdosing. Monitoring dabigatran levels may be crucial for optimizing treatment efficacy and safety in certain individuals.

Area of Science:

  • Cardiology
  • Pharmacology

Background:

  • Nonvalvular atrial fibrillation (NVAF) necessitates anticoagulation to prevent thromboembolism.
  • Dabigatran, a direct thrombin inhibitor, is an alternative to warfarin for NVAF patients.
  • Standard dabigatran dosing (110 mg twice daily) was initiated in this patient.

Observation:

  • A 60-year-old male with NVAF switched from acenocoumarol to dabigatran.
  • After five months, the patient developed significant thromboembolic complications including atrial thrombus, limb ischemia, and multiple organ infarcts.
  • Serum dabigatran levels were found to be low (35 ng/ml at 6 hours post-dose, 24-27 ng/mL trough).

Findings:

  • The patient's thromboembolic events correlated with subtherapeutic dabigatran concentrations.
  • Exclusion of other thromboembolic risk factors strengthens the link to dabigatran levels.
  • This suggests individual variability in dabigatran pharmacokinetics may impact efficacy.

Implications:

  • Therapeutic drug monitoring of dabigatran serum levels may be warranted in select patients.
  • Dose adjustments based on blood concentrations could improve treatment effectiveness and prevent adverse events.
  • This case underscores the importance of personalized anticoagulation strategies.

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