Key result
An 85-year-old man developed a large left ventricular mural thrombus despite over a year of treatment with dabigatran and clopidogrel, which failed to resolve after switching to warfarin.
Why the study?
Can left ventricular mural thrombus form and persist despite treatment with dabigatran, clopidogrel, and subsequently warfarin in a patient with severe heart failure?
Case Report (n=1)
No
Can left ventricular mural thrombus form and persist despite treatment with dabigatran, clopidogrel, and subsequently warfarin in a patient with severe heart failure?
This case highlights the potential for left ventricular mural thrombus formation and persistence despite treatment with dabigatran, clopidogrel, and subsequently warfarin in a high-risk patient, emphasizing the need for guidelines on anticoagulant use in this setting.
Persistent LV thrombus despite anticoagulation signals need for dedicated guidelines; leaves open optimal regimens in HF with AF.
We describe a case with severe heart failure and moderate aortic stenosis. Due to previous atrial fibrillation and ischaemic heart disease, this patient was treated with both dabigatran and clopidogrel. Despite this, a large mural thrombus was found on echocardiography. The treatment was altered to warfarin, but the thrombus did not resolve during the next eight months.Guidelines for the use of anticoagulant treatment in left ventricular thrombus are needed. Previously, a few cases presenting resistance to novel oral anticoagulants have been published and cases with thrombus formation due to dabigatran have been described. Our patient showed resistance to both dabigatran and warfarin, and there was no thrombus resolution when changing the treatment to warfarin.
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Fredgart et al. (2018) conducted a case report in Left ventricular mural thrombus (n=1). Dabigatran and clopidogrel was evaluated on Thrombus formation and resolution. An 85-year-old man developed a large left ventricular mural thrombus despite over a year of treatment with dabigatran and clopidogrel, which failed to resolve after switching to warfarin.
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