Rosa GM, Parodi A, Dorighi U, Carbone F, Mach F, Quercioli A, Montecucco F, Vuilleumier N, Balbi M, Brunelli C. Left atrial thrombosis in an anticoagulated patient after bioprosthetic valve replacement: Report of a case. World J Clin Cases 2014; 2(1): 20-23 [PMID: 24527429 DOI: 10.12998/wjcc.v2.i1.20]
Corresponding Author of This Article
Fabrizio Montecucco, MD, PhD, Division of Cardiology, Department of Internal Medicine, Foundation for Medical Researches, University of Geneva, 6 viale Benedetto XV, 1211 Geneva, Switzerland. fabrizio.montecucco@unige.ch
Research Domain of This Article
Cardiac & Cardiovascular Systems
Article-Type of This Article
Case Report
Open-Access Policy of This Article
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World J Clin Cases. Jan 16, 2014; 2(1): 20-23 Published online Jan 16, 2014. doi: 10.12998/wjcc.v2.i1.20
Left atrial thrombosis in an anticoagulated patient after bioprosthetic valve replacement: Report of a case
Gian Marco Rosa, Antonello Parodi, Ulrico Dorighi, Federico Carbone, François Mach, Alessandra Quercioli, Fabrizio Montecucco, Nicolas Vuilleumier, Manrico Balbi, Claudio Brunelli
Gian Marco Rosa, Antonello Parodi, Ulrico Dorighi, Manrico Balbi, Claudio Brunelli, Clinic of Cardiovascular Diseases, Internal Medicine Department, San Martino Hospital and University of Genoa, 16143 Genoa, Italy
Federico Carbone, François Mach, Alessandra Quercioli, Fabrizio Montecucco, Division of Cardiology, Department of Internal Medicine, Foundation for Medical researches, University of Geneva, 1211 Geneva, Switzerland
Fabrizio Montecucco, the First Medical Clinic, Laboratory of Phagocyte Physiopathology and Inflammation, Department of Internal Medicine, University of Genoa, 16143 Genoa, Italy
Nicolas Vuilleumier, Division of Laboratory Medicine, Department of Genetics and Laboratory Medicine, Geneva University Hospitals, 1211 Geneva, Switzerland
Author contributions: Rosa GM, Balbi M and Brunelli C designed the report; Parodi A and Dorighi U collected the patient’s clinical data; Rosa GM, Carbone F, Mach F, Quercioli A, Montecucco F and Vuilleumier N analyzed the data and wrote the paper.
Supported by Swiss National Science Foundation, No. 310030_118245 and No. 32003B_134963/1
Correspondence to: Fabrizio Montecucco, MD, PhD, Division of Cardiology, Department of Internal Medicine, Foundation for Medical Researches, University of Geneva, 6 viale Benedetto XV, 1211 Geneva, Switzerland. fabrizio.montecucco@unige.ch
Telephone: +41-22-3827238 Fax: +41-22-3827245
Received: October 28, 2013 Revised: November 29, 2013 Accepted: December 17, 2013 Published online: January 16, 2014 Processing time: 79 Days and 23.5 Hours
Abstract
We present the case of a 74 year old woman suffering from severe mitral valve incompetence and rapid atrial fibrillation. After an appropriate vitamin K antagonist (VKA) therapy, the patient underwent mitral valve replacement by bioprosthesis. Then, the patient was re-hospitalized for jaundice. Suspecting hepatotoxicity, VKA was discontinued and fondaparinux was started. During this treatment, the patient developed a symptomatic atrial thrombus. After exclusion of a hepatic disease, VKA was re-established with hemodynamic and liver enzymes normalization and atrial thrombus resolution. Caution has to be used when considering fondaparinux as an alternative strategy to VKA in patients with multiple thrombotic risk factors.
Core tip: Thromboembolism represents an important complication following heart valve replacement. This case report shows that although vitamin K antagonist (VKA) treatment represents the elective therapy in patients with left atrial thrombosis without mitral valve dysfunction, it may not be sufficient to avoid thrombogenesis. We also recommend that the discontinuation of VKA during the first three months after mitral valve surgery has to be carefully considered, especially in high thromboembolic risk patients.
