Abuzeid Wael, Al-Lawati Hatim, Fam Neil
Division of Cardiology, St. Michael's Hospital, University of Toronto, Toronto, Canada.
Oman Med J. 2015 Jan;30(1):55-8. doi: 10.5001/omj.2015.10.
Dabigatran etexilate is a recently approved direct thrombin inhibitor (DTI), which is superior to warfarin in the prevention of stroke and systemic embolism in patients with atrial fibrillation (AF). However, dabigatran use is associated with an increased risk of myocardial infarction (MI) compared to warfarin. The mechanisms for this association effect remain speculative. We present a case of an acute MI and cardiac arrest in a patient with chronic AF who had been recently switched from warfarin to dabigatran. Urgent coronary angiography, at St. Michael's hospital (Toronto, Canada), revealed evidence of thromboembolism to the distal posterior descending artery. The patient was treated medically and switched back from dabigatran to warfarin. He did well and was discharged after an uneventful stay in the coronary care unit.
达比加群酯是一种最近获批的直接凝血酶抑制剂（DTI），在预防心房颤动（AF）患者的中风和全身性栓塞方面优于华法林。然而，与华法林相比，使用达比加群会增加心肌梗死（MI）的风险。这种关联效应的机制仍具有推测性。我们报告一例慢性AF患者，近期从华法林转换为达比加群后发生急性心肌梗死和心脏骤停。在加拿大多伦多圣迈克尔医院进行的紧急冠状动脉造影显示，远端后降支动脉有血栓栓塞迹象。该患者接受了药物治疗，并从达比加群换回华法林。他恢复良好，在冠心病监护病房平稳住院后出院。
