Key result
In a patient with non-valvular atrial fibrillation, soluble fibrin levels remained elevated during apixaban therapy but normalized after switching to dabigatran, suggesting its utility for monitoring.
Why the study?
Does monitoring soluble fibrin levels help in selecting appropriate anticoagulants in patients with NVAF and hypercoagulability?
Case Report (n=1)
No
Does monitoring soluble fibrin levels help in selecting appropriate anticoagulants in patients with NVAF and hypercoagulability?
Monitoring soluble fibrin levels may be a useful index for evaluating hypercoagulability and selecting appropriate anticoagulants in patients with NVAF and malignancy.
Answers are grounded in this paper and cite their sources.
Soluble fibrin monitoring may aid anticoagulant selection in NVAF; hypothesis-generating and should not change practice without validation.
Warfarin, dabigatran, and apixaban are used for preventing ischemic stroke due to non-valvular atrial fibrillation (NVAF). However, it is often challenging to select the appropriate anticoagulant. We present the case of a 70-year-old male patient with persistent NVAF who developed pulmonary thromboembolism (PTE), deep vein thrombosis (DVT), and left atrial thrombus during anticoagulant therapy with warfarin. Intravenous recombinant tissue plasminogen activator was administered during his acute PTE. Heparin and apixaban were administered over 28 days; heparin was discontinued after the DVT resolved, while apixaban was administered to prevent ischemic stroke. Two days after heparin was discontinued, the patient experienced an ischemic stroke. Dabigatran was administered for secondary ischemic stroke prevention. Soluble fibrin (SF) levels remained elevated during treatment with heparin and apixaban and returned to normal after apixaban was replaced with dabigatran. Monitoring of SF may be useful as an index for selection of anticoagulants.
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Kawakami et al. (2015) conducted a case report in Non-valvular atrial fibrillation with pulmonary thromboembolism and deep vein thrombosis (n=1). Dabigatran vs. Apixaban / Warfarin was evaluated on Soluble fibrin (SF) levels and thrombosis recurrence. In a patient with non-valvular atrial fibrillation, soluble fibrin levels remained elevated during apixaban therapy but normalized after switching to dabigatran, suggesting its utility for monitoring.
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