Kao Pei-Heng, Chou Ping-Yin, Hsu Po-Chao, Huang Tien-Chi
Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital.
Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
Medicine (Baltimore). 2019 Jan;98(2):e14065. doi: 10.1097/MD.0000000000014065.
Although novel oral-anticoagulants are widely used in patients with atrial fibrillation (AF) for stroke prevention, there was only limited evidence for their use in left ventricular (LV) thrombus.
A 41-year-old man who presented with acute onset of right-hand clumsiness and aphasia even under high international normalized ratio (INR: 7.64) from warfarin use. He was previously treated with warfarin for the LV thrombus and non-valvular AF. Brain magnetic resonance imaging (MRI) showed multiple acute infarction in the cortex of the bilateral frontal lobes, left parietal lobe, and bilateral central semiovale, which highly suggested embolic stroke.
The repeated transthoracic echocardiogram still revealed LV thrombus (1.27 × 0.90 cm), which failed to respond to warfarin therapy.
Due to acute infarctions occurred under supratherapeutic range of INR, we switched warfarin to edoxaban (dose: 60 mg/day) after INR decreased to less than 2.
The thrombus disappeared after receiving edoxaban for 23 days, and no more recurrent stroke was noted for more than 6 months.
This is the first case demonstrates that while facing ineffective treatment of warfarin for LV thrombus, edoxaban could be safely and effectively used under this situation.
尽管新型口服抗凝药广泛用于心房颤动（AF）患者的卒中预防，但关于其用于左心室（LV）血栓形成的证据有限。
一名41岁男性，即便在华法林使用导致国际标准化比值（INR：7.64）很高的情况下，仍出现右手笨拙和失语急性发作。他之前因LV血栓形成和非瓣膜性AF接受华法林治疗。脑磁共振成像（MRI）显示双侧额叶、左侧顶叶和双侧中央半卵圆区皮质有多处急性梗死，高度提示为栓塞性卒中。
经胸超声心动图复查仍显示LV血栓（1.27×0.90厘米），华法林治疗无效。
由于在INR超治疗范围时发生急性梗死，在INR降至2以下后，我们将华法林换为依度沙班（剂量：60毫克/天）。
接受依度沙班治疗23天后血栓消失，6个多月未再发生卒中。
这是首例表明在华法林治疗LV血栓形成无效的情况下，依度沙班可在此种情况下安全有效地使用的病例。
