Key result
A 50-year-old male developed a massive left atrial thrombus and fatal thromboembolic stroke approximately two weeks after switching from warfarin to apixaban following atrial fibrillation ablation.
Case Report (n=1)
This case report describes a fatal thromboembolic event following a switch from warfarin to apixaban shortly after atrial fibrillation ablation, raising concerns about the efficacy of early NOAC use in this specific setting.
Potential risk with early apixaban post-AF ablation; hypothesis-generating and should not change practice.
Introduction Atrial fibrillation (AF) may result in thromboembolism often from a thrombus in the left atrium or atrial appendage accounting for nearly 15% of all strokes in the US, with an annual incidence of stroke of up to 6% or higher in some patients. Atrial fibrillation ablation, if successful over the long-term, may reduce the risk of future stroke. New anticoagulants, such as dabigatran, rivaroxaban, and apixaban, have been shown to be superior to warfarin to reduce the risk of stroke in non-valvular atrial fibrillation (NVAF), but no solid data are available to show if they are appropriate to utilize as an alternative to warfarin in patients undergoing catheter ablation procedures. Our case illustrated that such therapy may not be efficient.
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Farhoud et al. (2015) conducted a case report in Paroxysmal non-valvular atrial fibrillation (n=1). Apixaban vs. Warfarin was evaluated. A 50-year-old male developed a massive left atrial thrombus and fatal thromboembolic stroke approximately two weeks after switching from warfarin to apixaban following atrial fibrillation ablation.
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