Thrombus formation in left atrium on dabigatran therapy

Case Reports in Cardiology
Priyank ShahMahesh Bikkina

Abstract

Dabigatran is a direct thrombin inhibitor, approved in the United States for stroke prevention in nonvalvular atrial fibrillation and prevention and treatment of thromboembolism. It has been also used in patients with documented left atrial thrombus, where treatment with dabigatran effectively led to thrombus resolution. We present a rare case of left atrial thrombus formation in a patient with chronic atrial fibrillation being treated with dabigatran 150 mg twice a day. The patient presented with multiple embolic strokes. There are only three such cases reported in the literature till date, all of whom had thrombus in the left atrium. The possible mechanisms of dabigatran failure include compensatory increase in upstream coagulation factors due to single level downstream blockade of thrombin, lack of inhibition of all available thrombin, and lack of monitoring measures that can be implemented in common clinical laboratories that lead to failure to assess adherence, which in turn can lead to dabigatran failure.

References

Sep 9, 2005·The New England Journal of Medicine·Marcello Di NisioHarry R Büller
Sep 1, 2009·The New England Journal of Medicine·Stuart J ConnollyUNKNOWN RE-LY Steering Committee and Investigators
May 31, 2012·Journal of Thrombosis and Thrombolysis·Alejandro Vidal, Gabriel Vanerio
Apr 24, 2013·Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology·Yasutsugu NagamotoKenji Sadamatsu
May 23, 2013·Circulation. Cardiovascular Imaging·Sushil Allen LuisChristian Hamilton-Craig
Jun 28, 2013·American Journal of Therapeutics·Sanjiv SharmaRohan Sharma

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Citations

Sep 12, 2016·Journal of Thrombosis and Thrombolysis·Fabio MarsicoPasquale Perrone Filardi
Jun 1, 2018·BMJ Case Reports·Maise Fredgart, Sabine Gill

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