Dabigatran for intracardiac thrombus, yet another promising role of a direct oral anticoagulant: a case report and short review of literature

##plugins.themes.bootstrap3.article.main##

##plugins.themes.bootstrap3.article.sidebar##

Published Jun 27, 2022
DOI: https://doi.org/10.22551/2022.35.0902.10207
Piyush Kumar http://orcid.org/0000-0001-7399-4630 M Sudhakar Rao http://orcid.org/0000-0001-9439-3703 Kanhai Lalani http://orcid.org/0000-0001-7399-4630 Ganesh Paramasivam http://orcid.org/0000-0002-4332-3665 Tom Devasia http://orcid.org/0000-0002-7569-0670 Pankti Parikh http://orcid.org/0000-0003-1972-7683

Abstract

A left ventricular (LV) thrombus is a relatively common and well-known condition associated with significant LV systolic dysfunction. However, LV thrombosis is unusual in the absence of kinetic abnormalities. The elderly gentleman presented with subacute onset of bilateral lower limb discomfort and cold extremities, but no gangrene. With normal LV function, an echocardiogram revealed a massive movable LV apical clot. He was treated with dual antiplatelets and heparin at first. He switched to dabigatran 110 mg twice a day in combination with dual antiplatelets. The thrombus had entirely vanished and leg problems had improved after a 2-week follow-up. For the next six months, he was treated with aspirin and dabigatran and was asymptomatic at follow-up. There are no specific guidelines for treating an intracardiac thrombus. Experts agree that a hypermobile and pedunculated LV thrombus with a high embolic risk should be surgically removed as soon as possible. According to ESC/ACC guidelines, all patients with LV thrombus associated with myocardial infarction should be treated with anticoagulation. Warfarin requires regular International Normalized Ratio (INR) monitoring and has a small therapeutic window; hence a direct oral anticoagulant (DOAC) could be a viable therapeutic solution. However, there are no guideline recommendations to date to guide DOAC therapy for this indication.

##plugins.themes.bootstrap3.article.details##

Keywords

dabigatran, direct oral anticoagulants, left ventricular clot, intracardiac thrombus

References
1. McCarthy CP, Murphy S, Venkateswaran R V., et al. Left ventricular thrombus: contemporary etiologies, treatment strategies, and outcomes. J Am Coll Cardiol. 2019; 73(15):2007–2009. doi:10.1016/j.jacc.2019.01.031
2. PT O, FG K, DD A, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2013; 127(4). doi:10.1161/CIR.0b013e3182742cf6
3. Ibanez B, James S, Agewall S, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2018; 39(2):119–177. doi:10.1093/eurheartj/ehx393
4. Bennett S, Satchithananda D, Law G. The use of Apixaban for the treatment of an LV thrombus. Echo Res Pract. 2018; 5(4):K63–66. doi:10.1530/ERP-18-0036
5. Steg PG, James SK, Atar D, et al. ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J. 2012; 33(20):2569–2619. doi:10.1093/eurheartj/ehs215
6. Niemann M, Gaudron PD, Bijnens B, et al. Differentiation between fresh and old left ventricular thrombi by deformation imaging. Circ Cardiovasc Imaging. 2012; 5(5):667–675. doi:10.1161/CIRCIMAGING.112.974964
7. Kolekar S, Munjewar C, Sharma S. Dabigatran for left ventricular thrombus. Indian Heart J. 2015; 67(5):495–496. doi:10.1016/j.ihj.2015.06.010
8. Yamamoto T. Resolution of left ventricular thrombus after dabigatran therapy in two patients with old anteroseptal myocardial infarction. Cardiovasc Pharmacol Open Access. 2015; 04(03):3–5. doi:10.4172/2329-6607.1000152
9. Kajy M, Shokr M, Ramappa P. Use of direct oral anticoagulants in the treatment of left ventricular thrombus: systematic review of current literature. Am J Ther. 2020; 27(6):e584–590. doi:10.1097/MJT.0000000000000937
10. Leow AST, Sia CH, Tan BYQ, Loh JPY. A meta-summary of case reports of non-vitamin K antagonist oral anticoagulant use in patients with left ventricular thrombus. J Thromb Thrombolysis. 2018; 46(1):68–73. doi:10.1007/s11239-018-1656-8
How to Cite
Kumar, P., Rao, M. S., Lalani, K., Paramasivam, G., Devasia, T., & Parikh, P. (2022). Dabigatran for intracardiac thrombus, yet another promising role of a direct oral anticoagulant: a case report and short review of literature. Archive of Clinical Cases, 9(2), Arch Clin Cases 2022; 9(2):75-79. https://doi.org/10.22551/2022.35.0902.10207
Issue
Vol. 9 No. 2 (2022)
Section
Case Reports

Archive of Clinical Cases is protected by copyright and may be used in accordance with copyright and other applicable laws. Content available at www.clinicalcases.eu and our digital applications is intended for personal noncommercial use.

Authors who submit a manuscript for publication in Archive of Clinical Cases agree to the following terms: a. Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal. b. Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal. c. Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) only after the final version of the manuscript was accepted and published, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access). d. It is compulsory that before submission authors ensure that their work was not published in any other medical journals or pending acceptance for publication and that "Archives of Clinical Cases" is the only beneficiary at that moment if their work/case will be accepted by us.

Guidelines for linking to www.clinicalcases.eu a. The main purpose of the site linking to the Archive of Clinical Casess site should be educational. b. Links should be made to the Archive of Clinical Casess home page (www.clinicalcases.eu) or to the articles abstract. c. It is forbidden to use the Archive of Clinical Casess cover by outside organizations unless permission has been granted in advance, notifying our Secretary. d. Material owned by the Archive of Clinical Cases (including the name, logo, cover, and text) may not be used in any manner that may induce the idea or suggest that the Archive of Clinical Cases is in some way recommending a specific company, product or service. e. You must not use or allow others to access or use, all or any part of our Site or the contents and/or applications on it for commercial purposes without our permission. To seek permission to do anything prohibited by or not contained in these TERMS, or which requires our prior consent or agreement, you can contact us.

How to Cite

Kumar, P., Rao, M. S., Lalani, K., Paramasivam, G., Devasia, T., & Parikh, P. (2022). Dabigatran for intracardiac thrombus, yet another promising role of a direct oral anticoagulant: a case report and short review of literature. Archive of Clinical Cases, 9(2), Arch Clin Cases 2022; 9(2):75-79. https://doi.org/10.22551/2022.35.0902.10207