What is the clinical evidence from this study?

Study design: Case Report. Population: Left ventricular thrombus (n=1). Intervention: Dabigatran. Primary outcome: Resolution of left ventricular thrombus.

August 8, 2015Open Access

Dabigatran for left ventricular thrombus

Key Result

Dabigatran 110 mg twice a day for 4 months resulted in complete resolution of a left ventricular thrombus in a 61-year-old male patient without any bleeding or embolic episodes.

Study Design

Type

Case Report (n=1)

Multicenter

Structured PICO

Does dabigatran resolve left ventricular thrombus in a patient with hypertrophic cardiomyopathy?

Population

1 male patient with dilated phase of hypertrophic cardiomyopathy, history of multiple hospitalizations (CHF, stroke, scar epilepsy, atrial fibrillation, ventricular tachycardia), and a mobile mass in the left ventricle (LV thrombus) after discontinuing warfarin due to INR fluctuations.

Intervention

Dabigatran 110 mg twice a day for 4 months

Outcome

Resolution of left ventricular thrombus and absence of bleeding or embolic episodessurrogate

Dabigatran may be an effective alternative for resolving left ventricular thrombus in patients who cannot tolerate warfarin.

Limitations

Possibility of spontaneous clot lysis cannot be excluded
Short follow-up duration of 4 months
Single case observation that needs confirmation by larger and long-term data

Abstract

Male patient in dilated phase of hypertrophic cardiomyopathy had multiple hospitalizations during the past 2 years either due to congestive heart failure, stroke, scar epilepsy, or atrial fibrillation and ventricular tachycardia. Medication included evidence based therapy for heart failure, cordarone and warfarin. Anticoagulation had to be discontinued due to marked fluctuations in INR. Transthoracic Echocardiography (TTE) revealed a mobile mass in the left ventricle. He was treated with Dabigatran 110mg twice a day for 4 months without any bleeding or embolic episode and complete resolution of thrombus. Dabigatran is a reversible direct thrombin inhibitor and currently approved for the prevention of thromboembolic episodes in non-valvar atrial fibrillation. This case demonstrates possible thrombolytic properties of dabigatran in resolution of left ventricular thrombus.

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