Why the study?
Does reduced-dose apixaban resolve left atrial appendage thrombus in a patient with persistent atrial fibrillation and recent hemorrhagic stroke?
Does reduced-dose apixaban resolve left atrial appendage thrombus in a patient with persistent atrial fibrillation and recent hemorrhagic stroke?
Reduced-dose apixaban may be an effective and safe option for resolving left atrial appendage thrombus in patients with high bleeding risk, such as those with recent hemorrhagic stroke.
TEE mandatory before LAAOD to exclude thrombus in AF with recent hemorrhage; hypothesis-generating for device timing post-bleed.
A 63 year old woman with a history of persistent atrial fibrillation and CHADSVASC score of 2, suffered a massive stroke with a hemorrhagic transformation, 2 days following an appendectomy and reversal of warfarin anticoagulation with vitamin K. A left atrial appendage occlusive device (LAAOD) was considered for stroke prevention given the risk of recurrent cerebral hemorrhage. A transesophageal echocardiography (TEE) however, revealed left atrial appendage (LAA) clots which precluded the use of a LAAOD. A computed tomography revealed only partial resolution of the right hemispheric hematoma. Apixaban 2.5 mg twice daily was successful in resolving the LAA clots within 2 months without aggravating her cerebral hematoma which continued to resolve. This is the first case, to our knowledge showing reduced-dose Apixaban to completely resolve left atrial thrombus. Our case also addresses the issue of bridging following reversal of warfarin anticoagulation with vitamin K.
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Vaquerizo et al. (2015) studied this question.
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