A Case of Giant Mobile Left Atrial Thrombus during Dabigatran Therapy

Shun Sato＊	Takeshi Nishina＊	Masashi Yada＊
Yuichi Ueda＊	Kazuo Yamanaka＊

（Department of Cardiovascular Surgery, Nara Prefecture General Medical Center＊, Nara, Japan）

Dabigatran is a new/direct oral anticoagulant drug unlike warfarin. It is being increasingly used to prevent thromboembolism in patients with nonvalvular atrial fibrillation. We present the case of a 77-year-old woman with a giant left atrial thrombus in spite of anticoagulation therapy with dabigatran 300 mg/day. She had developed a cerebral infarction 18 months previously and was switched from warfarin to dabigatran. However, magnetic resonance imaging showed multiple new cerebral infarcts, and computed tomography scan and echocardiogram revealed a giant thrombus measuring 37×29 mm in the left atrium. Thrombectomy and left atrial appendage closure were urgently performed. Dabigatran was changed to warfarin again after the operation. She has had no recurrent thromboembolic event since then.

 

Jpn. J. Cardiovasc. Surg. 49:205-209（2020）

Keywords：left atrial thrombus;non valvular atrial fibrillation;dabigatran;DOAC