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Large Mobile Left Ventricular Thrombi Formation in a 32-Year-Old Despite Direct Oral Anticoagulation With Dabigatran

Lukas Damian Weberling1,2, Henning Steen1, Norbert Frey1,2

  • 1Department of Cardiology, Angiology and Pneumology, University Hospital Heidelberg, Heidelberg, Germany.

JACC. Case Reports
|September 5, 2022
PubMed

Insights

Direct oral anticoagulants (DOACs) can cause large left ventricular thrombi despite adequate use. A young patient developed these clots and required surgical removal, later switching to phenprocoumon for anticoagulation.

Area of Science:

  • Cardiology
  • Pharmacology

Background:

  • Direct oral anticoagulants (DOACs) are standard treatments for preventing arterial and venous thrombosis.
  • Ensuring adequate anticoagulation is crucial for patients on these medications.

Observation:

  • A 32-year-old patient on long-term DOAC therapy developed two large left ventricular thrombi.
  • The thrombi formed despite the patient adhering to the prescribed DOAC regimen.

Findings:

  • The patient underwent successful surgical thrombectomy to remove the left ventricular thrombi.
  • Post-surgery, anticoagulation was transitioned to phenprocoumon.

Implications:

  • This case highlights a rare complication of DOACs, suggesting potential risks even with appropriate dosing.
  • Further research may be needed to understand the mechanisms and identify patients at higher risk for DOAC-induced thrombosis.

Keywords:
CMRCMR, cardiac magnetic resonanceDOACDOAC, direct oral anticoagulantLAD, left anterior descendingLV, left ventricularSTEMI, ST-segment elevation myocardial infarctionVKA, vitamin K antagonistcase reportthrombus

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