Department of Neurology, Keio University School of Medicine, Tokyo, Japan.
Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.
Keio J Med. 2024 Sep 25;73(3):27-30. doi: 10.2302/kjm.2023-0017-CR. Epub 2024 Jul 10.
Some patients develop ischemic stroke despite taking direct oral anticoagulants because of the presence of other risk factors such as coagulopathies. A 65-year-old male patient with non-valvular atrial fibrillation (NVAF) taking rivaroxaban was diagnosed as having embolic stroke and antithrombin-III (AT-III) deficiency. Echocardiography revealed a thrombus in the left atrial appendage (LAA). He was prescribed warfarin, and after resolution of the thrombus, we successfully performed percutaneous LAA closure (LAAC), with no subsequent recurrence or device-related thrombosis. Warfarin and LAAC may be feasible for NVAF patients with AT-III deficiency.
有些患者尽管服用了直接口服抗凝剂，但由于存在其他危险因素（如凝血障碍），仍会发生缺血性脑卒中。一名 65 岁的男性非瓣膜性心房颤动（NVAF）患者正在服用利伐沙班，被诊断为栓塞性脑卒中合并抗凝血酶-III（AT-III）缺乏症。超声心动图显示左心耳（LAA）有血栓。他开始服用华法林，血栓溶解后，我们成功地进行了经皮左心耳封堵术（LAAC），此后没有再次发生或与器械相关的血栓。对于 AT-III 缺乏症的 NVAF 患者，华法林和 LAAC 可能是可行的。
