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达比加群作为对利伐沙班耐药的心房血栓形成的替代治疗:一例报告。

Dabigatran as an alternative for atrial thrombosis resistant to rivaroxaban: A case report.

作者信息

Sun Huan, Zhao Qini, Wang Yanjing, Lakin Robert, Liu Xueyan, Yu Ming, Yang Hongliang, Gao Dongmei, Chen Weiwei, Gao Guangyuan, Yan Mengjie, He Yuquan, Yang Ping

机构信息

Cardiology Department, China-Japan Union Hospital of Jilin University.

Jilin Provincial Cardiovascular Research Institute.

出版信息

Medicine (Baltimore). 2018 Dec;97(51):e13623. doi: 10.1097/MD.0000000000013623.

Abstract

RATIONALE

Anti-thrombosis therapy for atrial fibrillation (AF) management and stroke prevention is an important aspect of disease management. Novel oral anticoagulants (NOACs) are recommended by guidelines for AF management. However, if one can switch one NOAC to another when the former showed a poor effect has not been fully determined.

PATIENT CONCERNS

A 52-year-old man was admitted to our center for heart failure and AF with a thrombus in the left atrium.

DIAGNOSES

Cardiomyopathy was diagnosed by cardiac magnetic resonance (CMR) and echocardiography.

INTERVENTIONS

He was prescribed rivaroxaban (20 mg daily) as treatment, and dabigatran (150 mg twice daily) was used when the thrombus was found to be non-response to rivaroxaban.

OUTCOMES

The rivaroxaban did not diminish the atrial thrombus, and dabigatran was given instead which finally eliminated the thrombus.

LESSONS

Individualized responsiveness to NOACs should be considered and paid more attention to during clinical practice.

摘要

原理

抗血栓治疗对于心房颤动(AF)的管理和中风预防是疾病管理的一个重要方面。新型口服抗凝药(NOACs)被指南推荐用于AF管理。然而,当一种NOAC效果不佳时能否换用另一种尚未完全确定。

患者情况

一名52岁男性因心力衰竭和AF伴左心房血栓入住我院。

诊断

通过心脏磁共振成像(CMR)和超声心动图诊断为心肌病。

干预措施

给他开了利伐沙班(每日20毫克)作为治疗药物,当发现血栓对利伐沙班无反应时,改用达比加群(每日两次,每次150毫克)。

结果

利伐沙班未能减小心房血栓,改为使用达比加群,最终消除了血栓。

经验教训

在临床实践中应考虑并更加关注对NOACs的个体反应性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f7c0/6319865/8d125f5458ef/medi-97-e13623-g001.jpg

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