达比加群治疗导致心房颤动患者中对利伐沙班耐药的左心耳血栓溶解
Dabigatran Therapy Resulting in the Resolution of Rivaroxaban-resistant Left Atrial Appendage Thrombi in Patients with Atrial Fibrillation.
作者信息
Watanabe Tetsuya, Shinoda Yukinori, Ikeoka Kuniyasu, Minamisaka Tomoko, Fukuoka Hidetada, Inui Hirooki, Hoshida Shiro
机构信息
Department of Cardiovascular Medicine, Yao Municipal Hospital, Japan.
出版信息
Intern Med. 2017;56(15):1977-1980. doi: 10.2169/internalmedicine.56.8508. Epub 2017 Aug 1.
Abstract
Patients with persistent atrial fibrillation (AF) and a large left atrium are at a high risk for thromboembolisms. Recently, direct oral anticoagulants (DOACs) have mainly been used for the prevention of cardiac embolisms caused by AF. Transesophageal echocardiography (TEE) is performed in order to exclude any left atrial appendage (LAA) thrombi. We herein report two cases of persistent AF, both of which were treated with rivaroxaban for more than two years. Since TEE identified mobile LAA thrombi with this treatment, we switched from rivaroxaban to the direct thrombin inhibitor dabigatran. Dabigatran resolved the LAA thrombi that had been refractory to rivaroxaban.
摘要
持续性心房颤动（AF）且左心房较大的患者发生血栓栓塞的风险很高。近来，直接口服抗凝剂（DOACs）主要用于预防AF所致的心脏栓塞。进行经食管超声心动图（TEE）检查以排除任何左心耳（LAA）血栓。我们在此报告两例持续性AF患者，二者均接受利伐沙班治疗超过两年。由于TEE在此治疗过程中发现了活动的LAA血栓，我们将抗凝治疗从利伐沙班换为直接凝血酶抑制剂达比加群。达比加群使利伐沙班治疗无效的LAA血栓溶解。
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