A case of cardiac thrombosis developed under reduced dose apixaban therapy in a patient with non-valvular atrial fibrillation

Yıl 2017, Cilt: 9 Sayı: 3, 53 - 56, 01.12.2017

Mukadder Levent Çelik

Öz

Aim: Atrial fibrillation AF is the most common arrhythmia and the frequency increases with age. It is an irregular heart rhythm disorder with high morbidity and mortality, which can result in ischemic complications such as stroke resulting from heart-induced clot formation. In treatment, speed and rhythm control is provided in the first step. Patients are then evaluated for thromboembolism and risk of bleeding and appropriate anticoagulant therapy is regulated. In this study, we aimed to present a case of cardiac thrombus developing in a patient whose dose had to be reduced while under apixaban therapy. Case report: An 80-year-old hypertensive male patient with a history of atrial flutter ablation and coronary artery bypass grafting was diagnosed with paroxysmal atrial fibrillation PAF , and sotalol and apixaban treatment was initiated. A dose increase was made due to the development of cardiac thrombus in patient whose apixaban dose had to be reduced because of gastrointestinal bleeding, low weight and age progression. Because of the continuation of the thrombus, apixaban therapy was stopped and warfarin treatment was started. Control transesophageal echocardiographic TEE examination revealed that the thrombus had disappeared and the patient was discharged to follow up with the current warfarin treatment. Conclusion: In anticoagulant therapy of patients with atrial fibrillation, thromboembolic complications should be kept in mind while dose adjustment and drug exchange.

Anahtar Kelimeler

Apixaban, Atrial Fibrillation, Cardiac Trombus

Non-valvuler atrial fibrilasyonlu bir hastada azaltılmış doz apiksaban tedavisi altında gelişen kardiyak trombüs olgusu

Öz

Amaç: Atrial fibrilasyon AF , en sık görülen aritmidir ve sıklığı yaşla birlikte artmaktadır. Kalp kaynaklı pıhtı formasyonuna neden olup inme gibi iskemik komplikasyonlarla sonuçlanabilen, morbidite ve mortalitesi oldukça yüksek irregüler bir kalp ritm bozukluğudur. Tedavisinde ilk etapta hız ve ritm kontrolü sağlanır. Daha sonra tromboemboli ve kanama riski açısından hastalar değerlendirilir ve uygun antikoagülan tedavi düzenlenir. Bu çalışmada apiksaban tedavisi altında iken doz azaltılması gereken bir hastada gelişen kardiyak trombüs vakasını sunmayı amaçladık. Olgu sunumu: Atrial flutter nedeniyle ablasyon ve geçirilmiş coroner arter bypass grefting öyküsü olan 80 yaşında hipertansif erkek hasta, paroksismal atrial fibrilasyon PAF saptanması üzerine sotalol ve apiksaban tedavisi başlanarak takibe alınmış. Tedavi sürecinde gastrointestinal kanaması olması üzerine apiksaban dozu düşürülen hastanın takiplerinde kardiyak trombüs gelişmesi üzerine doz artışı yapıldı fakat trombüsün devam etmesi üzerine apiksaban tedavisi kesilerek varfarin tedavisi başlandı. Kontrol Transözefagial Ekokardiyografik TEE incelemede trombüsün kaybolduğu görülen hasta mevcut varfarin tedavisi ile takip edilmek üzere taburcu edildi. Sonuç: Atrial fibrilasyonlu hastaların antikoagülan tedavisinde, doz ayarlaması ve ilaç değişimi durumlarında tromboemboli gelişimi açısından dikkatli olunmalıdır.

Anahtar Kelimeler

Apiksaban, Atrial fibrilasyon, Kardiyak Trombüs

Kaynakça

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