Watanabe Shingo, Usui Michio, Egi Koso, Takazawa Kenji
The Department of Cardiology, Tokyo Yamate Medical Center, 3-22-1 Hyakunin-cho, Shinjuku-ku, Tokyo 169-0063, Japan.
J Cardiol Cases. 2020 Nov 24;23(5):221-223. doi: 10.1016/j.jccase.2020.11.011. eCollection 2021 May.
Direct oral anticoagulants (DOAC) are useful for preventing embolism and venous thrombosis in patients with atrial fibrillation. There are also reports that DOAC can dissolve existing intracardiac thrombus. Here, we report a case in which DOAC lysed a thrombus in an abdominal aortic aneurysm (AAA), resulting in impending rupture of the AAA. An 85-year-old woman was admitted to our hospital with a diagnosis of congestive heart failure. She has had atrial fibrillation and started taking DOAC. Computed tomography (CT) performed on admission revealed an AAA with a large amount of intraluminal thrombus (ILT). Fifty days after the start of DOAC, she visited our hospital with the chief complaint of severe abdominal pain. CT showed no enlargement of the AAA, but the ILT in the AAA had dissolved. She was diagnosed with an impending rupture of an AAA. She underwent emergency aortic replacement with a Y-shaped vascular prosthesis. When using DOAC in patients with aortic aneurysms with ILT, we need to be aware of the risk of the thrombus dissolving. < Direct oral anticoagulants (DOAC) are useful for preventing thrombosis in patients with atrial fibrillation. However, we experienced a case of abdominal aortic aneurysm in which intraluminal thrombus in the abdominal aortic aneurysm was dissolved by the use of DOAC, leading to impending rupture. It was considered as a complication that should be noted when using DOAC.>.
直接口服抗凝剂（DOAC）对于预防心房颤动患者的栓塞和静脉血栓形成很有用。也有报道称DOAC可以溶解现有的心内血栓。在此，我们报告一例DOAC溶解腹主动脉瘤（AAA）内血栓，导致AAA即将破裂的病例。一名85岁女性因充血性心力衰竭诊断入院。她患有心房颤动并开始服用DOAC。入院时进行的计算机断层扫描（CT）显示一个伴有大量腔内血栓（ILT）的AAA。开始服用DOAC 50天后，她因严重腹痛为主诉前来我院就诊。CT显示AAA无增大，但AAA内的ILT已溶解。她被诊断为AAA即将破裂。她接受了使用Y形血管假体的紧急主动脉置换术。在患有伴有ILT的主动脉瘤患者中使用DOAC时，我们需要意识到血栓溶解的风险。<直接口服抗凝剂（DOAC）对于预防心房颤动患者的血栓形成很有用。然而，我们遇到了一例腹主动脉瘤病例，其中腹主动脉瘤内的腔内血栓因使用DOAC而溶解，导致即将破裂。这被认为是使用DOAC时应注意的一种并发症。>
