Mesenter artery thrombosis despite effective oral anticoagulation treatment

Abstract

An 87-year-old woman was admitted to our emergency department with palpitation and fatigue 5 days ago. The patient with electrocardiography (ECG) Atrial Fibrillation (AF) has been treated with low molecular weight heparin and 5 mg / day warfarin for 5 days. After the fifth day of treatment the patient was admitted to the emergency department again with diffuse abdominal pain. On her physical examination there was generalized tenderness in the abdomen with no rebound. Blood biochemistry revealed elevated white blood cells and INR parameter was normal as 2.96. ECG showed atrial fibrillation. Abdominal computed tomographic angiography revealed a thrombotic appearance in SMA. Surgical intervention was offered to the patient, but she had refused to get a surgery. Afterwards, endovascular intervention to the SMA was planned. She had had an acute cardiac arrest and the patient had died. Our patient treated with heparin and warfarin for five days after the diagnosis of AF and developed acute SMA thromboembolism leading to acute mesenteric ischemia, although the INR value was in the therapeutic range. It is rare for acute mesenteric ischemia to occur beneath optimal anticoagulation therapy. In conclusion, acute mesenteric ischemia should be kept in mind in patients with normal INR values in case of severe abdominal pain.

Keywords

• acute mesenteric ischemia
• atrial fibrillation
• thromboembolism
• warfarin

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