Splenic infarction associated with persistent atrial fibrillation: A case report

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Splenic infarction associated with persistent atrial fibrillation (n=1). Intervention: Enoxaparin followed by Rivaroxaban. Primary outcome: Symptom resolution and clinical stability.

Q: What does this research mean for the field?

Therapeutic anticoagulation resolves symptoms rapidly and prevents recurrent thromboembolism in hemodynamically stable patients with atrial fibrillation-related splenic infarction. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

Lian Gao; Peng Lu; Qiang-Long Liu; Zhi-Lin Li; Pan-Gui Zhao; Qi-Yun Zhou; Jie Liu; Yin-Shan Feng; Zhen Li

doi:10.4330/wjc.126812

October 16, 2026World Journal of CardiologyOpen Access

Splenic infarction associated with persistent atrial fibrillation: A case report

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Why the study?

Splenic infarction is an uncommon thromboembolic condition associated with AF that presents with nonspecific abdominal manifestations, leading to diagnostic challenges.

Does timely initiation of therapeutic anticoagulation (enoxaparin followed by rivaroxaban) resolve symptoms and prevent recurrent embolic events in a patient with persistent atrial fibrillation presenting with acute cardioembolic splenic infarction?

Key Points

To describe a case of acute splenic infarction presenting with isolated left upper quadrant abdominal pain in a patient with persistent atrial fibrillation and inadequate anticoagulation.
Clinical and diagnostic evaluation of a 56-year-old male with a greater than 10-year history of persistent atrial fibrillation, coronary artery disease, heart failure, and a CHA2DS2-VASc score of 2.
Initial non-contrast abdominal computed tomography followed by contrast-enhanced computed tomography after initial imaging revealed no abnormalities.
Conservative management using therapeutic anticoagulation, analgesia, and supportive care.
Contrast-enhanced computed tomography identified a characteristic wedge-shaped splenic infarction that was not detected on the initial non-contrast scan.
Therapeutic anticoagulation resulted in rapid resolution of the patient's acute left upper quadrant pain without in-hospital complications.

Study Design

Type

Case Report (n=1)

Multicenter

No

Structured PICO

Does timely initiation of therapeutic anticoagulation (enoxaparin followed by rivaroxaban) resolve symptoms and prevent recurrent embolic events in a patient with persistent atrial fibrillation presenting with acute cardioembolic splenic infarction?

P

Population

1 male patient aged 56 years with persistent atrial fibrillation, heart failure, coronary artery disease, and acute splenic infarction, followed for 1 month.

I

Intervention

Enoxaparin 4000 U subcutaneously twice daily initiated within 2 hours of diagnosis (for 4 days during hospitalization, with discontinuation of aspirin), followed by rivaroxaban 20 mg oral once daily at discharge for long-term anticoagulation.

O

Outcome

Resolution of acute abdominal pain over 4 days of inpatient treatment and complete symptom resolution at 1-month outpatient follow-uppatient reported

In patients with persistent atrial fibrillation and inadequate anticoagulation presenting with acute left upper quadrant pain, contrast-enhanced CT is essential to diagnose splenic infarction—even when initial non-contrast CT is normal—and timely initiation of therapeutic anticoagulation can lead to rapid symptom resolution.

Limitations

Cardioembolic source was plausible but not proven, as transesophageal echocardiography was not performed and no intracardiac thrombus was directly demonstrated.
Alternative etiologies such as infective endocarditis, hematological disorders, malignancy, and hypercoagulable states were not comprehensively excluded.
The 1-month follow-up relied on clinical self-report without planned laboratory tests or repeat imaging due to the patient's financial limitations.
The cardioembolic source is plausible but not proven, as transesophageal echocardiography (TEE) was not performed and no intracardiac thrombus was demonstrated on transthoracic echocardiography or contrast-enhanced CT.
Alternative etiologies (such as infective endocarditis, hematological disorders, malignancy, and hypercoagulable states) were not comprehensively excluded.
The 1-month follow-up was based on clinical self-report without planned laboratory tests or repeat imaging due to financial limitations, preventing objective assessment of splenic infarction resolution, thrombus resolution, or occult bleeding.

Implication

Supports anticoagulation for AF-related splenic infarction in select cases; leaves open confirmation in prospective trials.

Abstract

BACKGROUND Splenic infarction is an uncommon thromboembolic condition associated with atrial fibrillation (AF) but with nonspecific abdominal manifestations, leading to diagnostic challenges. CASE SUMMARY A 56-year-old male with persistent AF and inadequate anticoagulation management presented with acute left upper quadrant pain without cardiac symptoms. Contrast-enhanced computed tomography was performed and revealed a characteristic wedge-shaped splenic infarction. Following therapeutic anticoagulation, the patient's symptoms rapidly resolved. CONCLUSION Acute left upper quadrant pain in patients with AF should raise a clinical suspicion of splenic infarction. The early initiation of therapeutic anticoagulation when cardioembolic etiology is suspected and contraindications are absent may contribute to a favorable outcome and reduce the risk of recurrent embolic events.

Discussion

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Cite This Study

Gao et al. (2026) conducted a case report in Splenic infarction associated with persistent atrial fibrillation (n=1). Enoxaparin followed by Rivaroxaban was evaluated on Symptom resolution and clinical stability.

synapsesocial.com/papers/6ae28e75cbadf70daf6c426a https://doi.org/10.4330/wjc.126812

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Splenic infarction associated with persistent atrial fibrillation: A case report

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

Splenic infarction associated with persistent atrial fibrillation: A case report

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

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