Successful anticoagulation therapy for a giant left atrial thrombus following mitral valve repair

A 72-year-old male with atrial fibrillation (AF) underwent mitral valve (MV) repair and concomitant procedures. He was discharged with therapeutic Warfarin dosing but was readmitted 3 weeks later with a right caudate nucleus infarct and subtherapeutic anticoagulation. Echocardiography showed a giant...

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Bibliographic Details
Published in:Journal of thoracic disease 2017-07, Vol.9 (7), p.E640-E643
Main Authors: Mathew, Eshani N, Pang, Philip Y K, Mori, Makoto, Chua, Yeow Leng, Sin, Yoong Kong
Format: Article
Language:English
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Case Report
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Summary:A 72-year-old male with atrial fibrillation (AF) underwent mitral valve (MV) repair and concomitant procedures. He was discharged with therapeutic Warfarin dosing but was readmitted 3 weeks later with a right caudate nucleus infarct and subtherapeutic anticoagulation. Echocardiography showed a giant left atrial (LA) thrombus. Low-molecular-weight heparin was promptly initiated. Unfortunately, the patient suffered an intracranial hemorrhage (ICH) 2 days later. He declined surgical thrombectomy and was managed conservatively, remaining stable without neurological deficits. Serial brain imaging showed interval stability, allowing Warfarin to be resumed. Follow-up echocardiography demonstrated partial and complete resolution of the thrombus at 1 and 3 months, respectively.
ISSN:2072-1439
2077-6624
DOI:10.21037/jtd.2017.06.84