Scarano Michele, Casale Matteo, Mantini Cesare, Imbalzano Egidio, Consorti Cristiana, Clemente Daniela, Dattilo Giuseppe
Cardiology Unit, Emergency Department, Hospital "Madonna del Soccorso", Via Silvio Pellico n.32, 63039, San Benedetto del Tronto, Ascoli Piceno, Italy.
Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
J Med Case Rep. 2017 Apr 9;11(1):97. doi: 10.1186/s13256-017-1249-8.
Atrial fibrillation is the most common cardiac arrhythmia. It is responsible for up to 20% of all ischemic strokes. Rate control and anticoagulation are crucial for atrial fibrillation management and stroke prevention.
We present the case of an 84-year-old Italian woman with a left atrial appendage thrombus that developed despite her use of anticoagulant therapy with warfarin for a previous pulmonary embolism. She had atrial fibrillation and heterozygosity for both factor V Leiden and methylenetetrahydrofolate reductase C677T mutation, thus creating resistance to activated protein C. Anticoagulant therapy was switched to heparin for 1 week and then to rivaroxaban. After 3 months of rivaroxaban use, the thrombus disappeared.
This case raises the issue of the ineffectiveness of warfarin therapy in complex cases involving particular thrombophilic conditions and the possibility of using rivaroxaban as a safe and effective alternative.
心房颤动是最常见的心律失常。它导致的缺血性中风占所有缺血性中风的20%。心率控制和抗凝对于心房颤动的管理及预防中风至关重要。
我们报告一例84岁意大利女性病例，该患者尽管之前因肺栓塞使用华法林进行抗凝治疗，但仍发生了左心耳血栓。她患有心房颤动，同时存在因子V莱顿突变和亚甲基四氢叶酸还原酶C677T突变的杂合性，从而产生了对活化蛋白C的抵抗。抗凝治疗改为使用肝素1周，然后改用利伐沙班。使用利伐沙班3个月后，血栓消失。
该病例提出了在涉及特定血栓形成倾向的复杂病例中华法林治疗无效的问题，以及使用利伐沙班作为安全有效替代药物的可能性。
