Khan Omar, Egbe Antoine, Abbasi Danish
Internal Medicine, McLaren Macomb Hospital, Mount Clemens, USA.
Internal Medicine, Arkansas College of Osteopathic Medicine, Fort Smith, USA.
Cureus. 2024 May 30;16(5):e61368. doi: 10.7759/cureus.61368. eCollection 2024 May.
A 79-year-old female with chronic atrial fibrillation was being treated with dabigatran (Pradaxa). Pradaxa was discontinued after a significant bleeding episode. A WATCHMAN device was successfully implanted and Pradaxa was started. A transesophageal echocardiogram (TEE) 49 days later showed a 3.6×2.2 cm clot overlying the device. Pradaxa was switched to Coumadin. Subsequent TEEs showed the complete resolution of the thrombus after five months on Coumadin. Coumadin was discontinued. Six months later, TEE showed a large mobile thrombus attached to the left atrial appendage occlusion device (LAAOD). The patient's hypercoagulable workup was negative. Due to recurrent thrombotic events, she was started on apixaban (Eliquis) due to a prior history of bleeding on Coumadin. She is currently on Eliquis with no further episodes of bleeding or device thrombus.
一名79岁患有慢性房颤的女性正在接受达比加群（Pradaxa）治疗。在发生一次严重出血事件后，停用了Pradaxa。成功植入了WATCHMAN装置，并重新开始使用Pradaxa。49天后经食管超声心动图（TEE）显示装置上有一个3.6×2.2厘米的血栓。将Pradaxa换为华法林。随后的TEE显示在使用华法林五个月后血栓完全溶解。停用了华法林。六个月后，TEE显示一个大的活动血栓附着在左心耳封堵装置（LAAOD）上。患者的高凝检查结果为阴性。由于既往使用华法林时有出血史且出现复发性血栓事件，开始使用阿哌沙班（Eliquis）。她目前正在服用Eliquis，未再发生出血或装置血栓事件。
