Key result
Intravenous UFH for LAA thrombus fails to prevent lower limb embolism in a thrombophilia case.
Why the study?
Management of left atrial appendage thrombus in patients with thrombophilia-related mutations and associated complications is not well characterized.
Case Report (n=1)
This case highlights the challenges of managing an LAA thrombus in a patient with underlying thrombophilia (factor V Leiden and MTHFR mutations) who experienced recurrent embolic events despite anticoagulation.
Answers are grounded in this paper and cite their sources.
Embolization may occur during UFH for LAA thrombus in thrombophilia; leaves open optimal management strategies.
Trans-esophageal echocardiography (TEE) revealed a left atrial appendage (LAA) thrombus in an 84-year-old woman with nonvalvular atrial fibrillation not known before our evaluation. In her medical history, there were hypertension, dyslipidemia and a previous pulmonary embolism. She was taking warfarin at time of our evaluation and presented signs and symptoms of heart failure. Together with heart failure treatment, intravenous anticoagulation with unfractionated heparin was initiated. Treatment was complicated by additional right lower limb embolic event and the LAA thrombus remained unchanged. Testing revealed heterozygosity for both the factor V Leiden and the methylenetetrahydrofolate reductase C677T mutations inducing resistance to activated protein C. The patient refused transcatheter closure of the left atrial appendage.
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Parato et al. (2014) conducted a case report in Left atrial appendage thrombus and nonvalvular atrial fibrillation (n=1). Intravenous anticoagulation with unfractionated heparin was evaluated. Intravenous anticoagulation with unfractionated heparin for a left atrial appendage thrombus in an 84-year-old woman with thrombophilia was complicated by a right lower limb embolic event.
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