FRINK Linked Data Fragments server

Matches in SemOpenAlex for { <https://semopenalex.org/work/W2172068661> ?p ?o ?g. }

• W2172068661 endingPage "492" @default.
• W2172068661 startingPage "491" @default.
• W2172068661 abstract "HomeCirculation: Cardiovascular ImagingVol. 6, No. 3Massive Left Atrial Thrombus in a Patient With Rheumatic Mitral Stenosis and Atrial Fibrillation While Anticoagulated With Dabigatran Free AccessResearch ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissionsDownload Articles + Supplements ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toSupplemental MaterialFree AccessResearch ArticlePDF/EPUBMassive Left Atrial Thrombus in a Patient With Rheumatic Mitral Stenosis and Atrial Fibrillation While Anticoagulated With Dabigatran Sushil Allen Luis, Karl Poon, Chris Luis, Akhil Shukla, Nicholas Bett and Christian Hamilton-Craig Sushil Allen LuisSushil Allen Luis From the Department of Cardiology, The Prince Charles Hospital, Brisbane, Queensland, Australia. Search for more papers by this author , Karl PoonKarl Poon From the Department of Cardiology, The Prince Charles Hospital, Brisbane, Queensland, Australia. Search for more papers by this author , Chris LuisChris Luis From the Department of Cardiology, The Prince Charles Hospital, Brisbane, Queensland, Australia. Search for more papers by this author , Akhil ShuklaAkhil Shukla From the Department of Cardiology, The Prince Charles Hospital, Brisbane, Queensland, Australia. Search for more papers by this author , Nicholas BettNicholas Bett From the Department of Cardiology, The Prince Charles Hospital, Brisbane, Queensland, Australia. Search for more papers by this author and Christian Hamilton-CraigChristian Hamilton-Craig From the Department of Cardiology, The Prince Charles Hospital, Brisbane, Queensland, Australia. Search for more papers by this author Originally published1 May 2013https://doi.org/10.1161/CIRCIMAGING.113.000253Circulation: Cardiovascular Imaging. 2013;6:491–492IntroductionDabigatran is an oral direct thrombin inhibitor licensed for use by the Food and Drug Administration.1,2 This novel anticoagulant is effective and approved for prevention of stroke and systemic embolism in nonvalvular atrial fibrillation (AF) and prevention of venous thromboembolism in adults receiving elective total hip or knee replacement surgery.1,2 These images present a cautionary account of failed dabigatran anticoagulation in a patient with valvular AF: an indication for which its use has not been approved.A 50-year-old female with severe rheumatic mitral stenosis underwent open mitral valvotomy under cardiopulmonary bypass 25 years prior. On subsequent annual surveillance, she remained asymptomatic and her mitral stenosis remained moderate on echocardiography with a mean transmitral gradient of 8 mm Hg. Permanent AF was previously diagnosed 12 months earlier, and she was commenced on warfarin and metoprolol.She had stable anticoagulation monitoring, no bleeding complications, and normal renal function, but was needle-phobic with psychological stress from regular international normalized ratio monitoring. Her family physician considered it worthwhile to switch from warfarin to dabigatran (150 mg BID). A recent transthoracic ECG performed 2 months before the commencement of dabigatran had shown no atrial thrombus (Figure A).Download figureDownload PowerPointFigure. A, Transthoracic echo 2 months before commencement of dabigatran, while on therapeutic Warfarin demonstrating a dilated left atrium but no thrombus. B, Four-chamber transthoracic image after 4 months on dabigatran showing a large echogenic mass in the posterior left atrium (arrow; Video I in the online-only Data Supplement). C, Four-chamber zoom image demonstrating the 4×4 cm mass. D, Cardiac MRI steady state free precession image*, 4-chamber view, showing a large mass in the left atrium, and thickened mitral valve leaflets with turbulence during diastole (Video II in the online-only Data Supplement). E, Late gadolinium enhancement MRI image*, 4-chamber view, demonstrating absence of signal in the mass, confirming it as a large thrombus. F, Four-chamber zoom transthoracic echocardiographic image at 11-month follow-up post rewarfarinization demonstrated marked reduction in thrombus size, now measuring 2.4×1.7 cm (Video III in the online-only Data Supplement).Four months later, routine transthoracic echocardiography demonstrated a large homogenous mobile mass in her dilated left atrium (Figure B and C). Cardiac MRI was performed to differentiate thrombus from tumor and confirmed a large, low signal mass adherent to the left atrial wall without gadolinium enhancement, consistent with thrombus (Figure D and E). She had been compliant with dabigatran. Dabigatran was ceased, and warfarin recommenced under intravenous heparin cover.She was well at 11-month follow-up with no embolic complications and marked reduction in thrombus size on repeated imaging (Figure F).DiscussionThese images demonstrate the first documented case of thrombosis in AF with coexistent valvular heart disease (without valve replacement), despite anticoagulation with a direct thrombin inhibitor.At present, there is minimal data available on the efficacy of dabigatran in valvular heart disease. Four cases of thrombosis complicating dabigatran use in the setting of bileaflet mechanical valve prostheses have been reported in the literature.1–3 Although the majority of patients presented with dyspnea resulting from mechanical valve thrombosis, stroke complicating valvular thrombus has also been demonstrated.1–3 The propensity for valvular thrombus does not seem to be affected by valve position with both mechanical aortic and mitral valvular thrombus demonstrated.1–3 Further study is hence required before the routine use of dabigatran outside currently approved indications.The present recruiting Randomized, phase II study to Evaluate the sAfety and pharmacokinetics of oraL dabIGatran etexilate in patients after heart valve replacemeNt trial4 will evaluate the therapeutic dosing of dabigatran (150, 220, and 300 mg BID) against warfarin in patients with bileaflet mechanical heart valves. It is hoped that this data will provide definitive results regarding the use of direct thrombin inhibitors in this clinical setting. However, results from this trial are unlikely to be sufficient to address the issue of direct thrombin inhibitors for prevention of embolic events in patients with native valvular disease and AF. Further randomized trials are required to address the efficacy of direct thrombin inhibitor efficacy in patients with native valvular AF.In the interim off-label usage of dabigatran, particularly in valvular heart disease, both with and without valve replacement should be avoided outside the clinical trial setting until further evidence becomes available. Clinicians need to remain aware that direct thrombin inhibitors have demonstrated efficacy in only limited clinical scenarios (stroke prevention in nonvalvular AF and postsurgical venous thromboprophylaxis), and that usage outside these settings should be strongly avoided. Medication use outside such approved indications warrant careful consideration of the risks associated with administering therapy of unknown clinical efficacy.DisclosuresNone.FootnotesThe online-only Data Supplement is available at http://circimaging.ahajournals.org/lookup/suppl/doi:10.1161/CIRCIMAGING.113.000253/-/DC1.Correspondence to Sushil Luis, MBBS, FRACP, Department of Cardiology, The Prince Charles Hospital, Rode Rd, Chermside, Brisbane, Queensland 4032, Australia. E-mail [email protected]References1. Stewart RA, Astell H, Young L, White HD. Thrombosis on a mechanical aortic valve whilst anti-coagulated with dabigatran.Heart Lung Circ. 2012; 21:53–55.CrossrefMedlineGoogle Scholar2. Chu JW, Chen VH, Bunton R. Thrombosis of a mechanical heart valve despite dabigatran.Ann Intern Med. 2012; 157:304.CrossrefMedlineGoogle Scholar3. Price J, Hynes M, Labinaz M, Ruel M, Boodhwani M. Mechanical valve thrombosis with dabigatran.J Am Coll Cardiol. 2012; 60:1710–1711.CrossrefMedlineGoogle Scholar4. Van de Werf F, Brueckmann M, Connolly SJ, Friedman J, Granger CB, Härtter S, Harper R, Kappetein AP, Lehr T, Mack MJ, Noack H, Eikelboom JW. A comparison of dabigatran etexilate with warfarin in patients with mechanical heart valves: The Randomized, phase II study to Evaluate the sAfety and pharmacokinetics of oraL dabIGatran etexilate in patients after heart valve replacemeNt (RE-ALIGN).Am Heart J. 2012; 163:931–937.CrossrefMedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited By Ahn J, Burke C, Howitt L, Glenie T and Lau G (2021) A case of massive left atrial thrombus, Echocardiography, 10.1111/echo.15217, 39:1, (104-108), Online publication date: 1-Jan-2022. Sato S, Nishina T, Yada M, Ueda Y and Yamanaka K (2020) A Case of Giant Mobile Left Atrial Thrombus during Dabigatran Therapyダビガトラン投与下に巨大左房内遊離血栓を認めた1例, Japanese Journal of Cardiovascular Surgery, 10.4326/jjcvs.49.205, 49:4, (205-209), Online publication date: 15-Jul-2020. Candelaresi P, Iannuzzi A, Servillo G, Gottilla R, Brown R, Bera D, Parma R, Akhtar M and Mehta V (2020) Left atrial appendage thrombus on full-dose dabigatran treatment: a case report, European Heart Journal - Case Reports, 10.1093/ehjcr/ytaa057, 4:3, (1-4), Online publication date: 1-Jun-2020. Loh C and Herkes G (2019) Republished: Successful thrombolysis for acute ischaemic stroke after reversal of dabigatran etexilate with idarucizumab, Drug and Therapeutics Bulletin, 10.1136/dtb.2019.229128rep, 57:9, (141-143), Online publication date: 1-Sep-2019. Loh C and Herkes G (2019) Successful thrombolysis for acute ischaemic stroke after reversal of dabigatran etexilate with idarucizumab, BMJ Case Reports, 10.1136/bcr-2018-229128, 12:5, (e229128), Online publication date: 1-May-2019. Gu Z, Ma X, Zheng X, Shen L, Shi F and Li H (2018) Left Atrial Appendage Thrombus Formation in a Patient on Dabigatran Therapy Associated With ABCB1 and CES-1 Genetic Defect, Frontiers in Pharmacology, 10.3389/fphar.2018.00491, 9 Briasoulis A, Inampudi C, Akintoye E, Alvarez P, Panaich S and Vaughan‐Sarrazin M (2018) Safety and Efficacy of Novel Oral Anticoagulants Versus Warfarin in Medicare Beneficiaries With Atrial Fibrillation and Valvular Heart Disease, Journal of the American Heart Association, 7:8, Online publication date: 17-Apr-2018.Aronis K and Hylek E (2018) Evidence Gaps in the Era of Non–Vitamin K Oral Anticoagulants, Journal of the American Heart Association, 7:3, Online publication date: 6-Feb-2018. Marsico F, Cecere M, Parente A, Paolillo S, de Martino F, Dellegrottaglie S, Trimarco B and Perrone Filardi P (2016) Effects of novel oral anticoagulants on left atrial and left atrial appendage thrombi: an appraisal, Journal of Thrombosis and Thrombolysis, 10.1007/s11239-016-1421-9, 43:2, (139-148), Online publication date: 1-Feb-2017. Muthiah R (2017) Rheumatic Giant Left Atrium—An Overview, Case Reports in Clinical Medicine, 10.4236/crcm.2017.66017, 06:06, (164-195), . Di Biase L (2016) Use of Direct Oral Anticoagulants in Patients With Atrial Fibrillation and Valvular Heart Lesions, Journal of the American Heart Association, 5:2, Online publication date: 23-Feb-2016. De Caterina R and John Camm A (2015) Non-vitamin K antagonist oral anticoagulants in atrial fibrillation accompanying mitral stenosis: the concept for a trial, Europace, 10.1093/europace/euv288, 18:1, (6-11), Online publication date: 1-Jan-2016. Kolekar S, Munjewar C and Sharma S (2015) Dabigatran for left ventricular thrombus, Indian Heart Journal, 10.1016/j.ihj.2015.06.010, 67:5, (495-496), Online publication date: 1-Sep-2015. Mitamura H, Nagai T, Watanabe A, Takatsuki S and Okumura K (2015) Left atrial thrombus formation and resolution during dabigatran therapy: A Japanese Heart Rhythm Society report, Journal of Arrhythmia, 10.1016/j.joa.2014.12.010, 31:4, (226-231), Online publication date: 1-Aug-2015. Di Pasquale G, Zagnoni S and Riva L (2015) Novel oral anticoagulants and valvular atrial fibrillation: are they always contraindicated?, Internal and Emergency Medicine, 10.1007/s11739-014-1181-5, 10:1, (21-24), Online publication date: 1-Feb-2015. Shah P, Mithawala P, Konlian D, Soyombo A and Bikkina M (2015) Thrombus Formation in Left Atrium on Dabigatran Therapy, Case Reports in Cardiology, 10.1155/2015/518982, 2015, (1-2), . Murdoch D, McAulay L and Walters D (2014) Combined percutaneous balloon mitral valvuloplasty and left atrial appendage occlusion device implantation for rheumatic mitral stenosis and atrial fibrillation, Cardiovascular Revascularization Medicine, 10.1016/j.carrev.2014.04.007, 15:8, (428-431), Online publication date: 1-Nov-2014. May 2013Vol 6, Issue 3 Advertisement Article InformationMetrics © 2013 American Heart Association, Inc.https://doi.org/10.1161/CIRCIMAGING.113.000253PMID: 23696587 Manuscript receivedFebruary 1, 2013Manuscript acceptedMarch 26, 2013Originally publishedMay 1, 2013 Keywordsdabigatranvalvular heart diseasePDF download Advertisement SubjectsAnticoagulantsArrhythmiasComputerized Tomography (CT)EchocardiographyPrimary Prevention" @default.
• W2172068661 created "2016-06-24" @default.
• W2172068661 creator A5022531174 @default.
• W2172068661 creator A5029164827 @default.
• W2172068661 creator A5038064913 @default.
• W2172068661 creator A5059549811 @default.
• W2172068661 creator A5078015313 @default.
• W2172068661 creator A5082158845 @default.
• W2172068661 date "2013-05-01" @default.
• W2172068661 modified "2023-10-18" @default.
• W2172068661 title "Massive Left Atrial Thrombus in a Patient With Rheumatic Mitral Stenosis and Atrial Fibrillation While Anticoagulated With Dabigatran" @default.
• W2172068661 cites W1979485721 @default.
• W2172068661 cites W2064696767 @default.
• W2172068661 cites W2073333024 @default.
• W2172068661 cites W2140131862 @default.
• W2172068661 doi "https://doi.org/10.1161/circimaging.113.000253" @default.
• W2172068661 hasPubMedId "https://pubmed.ncbi.nlm.nih.gov/23696587" @default.
• W2172068661 hasPublicationYear "2013" @default.
• W2172068661 type Work @default.
• W2172068661 sameAs 2172068661 @default.
• W2172068661 citedByCount "18" @default.
• W2172068661 countsByYear W21720686612014 @default.
• W2172068661 countsByYear W21720686612015 @default.
• W2172068661 countsByYear W21720686612016 @default.
• W2172068661 countsByYear W21720686612017 @default.
• W2172068661 countsByYear W21720686612018 @default.
• W2172068661 countsByYear W21720686612019 @default.
• W2172068661 countsByYear W21720686612020 @default.
• W2172068661 countsByYear W21720686612021 @default.
• W2172068661 countsByYear W21720686612023 @default.
• W2172068661 crossrefType "journal-article" @default.
• W2172068661 hasAuthorship W2172068661A5022531174 @default.
• W2172068661 hasAuthorship W2172068661A5029164827 @default.
• W2172068661 hasAuthorship W2172068661A5038064913 @default.
• W2172068661 hasAuthorship W2172068661A5059549811 @default.
• W2172068661 hasAuthorship W2172068661A5078015313 @default.
• W2172068661 hasAuthorship W2172068661A5082158845 @default.
• W2172068661 hasBestOaLocation W21720686611 @default.
• W2172068661 hasConcept C126322002 @default.
• W2172068661 hasConcept C164705383 @default.
• W2172068661 hasConcept C2776301958 @default.
• W2172068661 hasConcept C2778810321 @default.
• W2172068661 hasConcept C2779161974 @default.
• W2172068661 hasConcept C2780007028 @default.
• W2172068661 hasConcept C2780703314 @default.
• W2172068661 hasConcept C2781362458 @default.
• W2172068661 hasConcept C71924100 @default.
• W2172068661 hasConceptScore W2172068661C126322002 @default.
• W2172068661 hasConceptScore W2172068661C164705383 @default.
• W2172068661 hasConceptScore W2172068661C2776301958 @default.
• W2172068661 hasConceptScore W2172068661C2778810321 @default.
• W2172068661 hasConceptScore W2172068661C2779161974 @default.
• W2172068661 hasConceptScore W2172068661C2780007028 @default.
• W2172068661 hasConceptScore W2172068661C2780703314 @default.
• W2172068661 hasConceptScore W2172068661C2781362458 @default.
• W2172068661 hasConceptScore W2172068661C71924100 @default.
• W2172068661 hasIssue "3" @default.
• W2172068661 hasLocation W21720686611 @default.
• W2172068661 hasLocation W21720686612 @default.
• W2172068661 hasOpenAccess W2172068661 @default.
• W2172068661 hasPrimaryLocation W21720686611 @default.
• W2172068661 hasRelatedWork W1973989324 @default.
• W2172068661 hasRelatedWork W1994905407 @default.
• W2172068661 hasRelatedWork W2019213995 @default.
• W2172068661 hasRelatedWork W2063976695 @default.
• W2172068661 hasRelatedWork W2085025615 @default.
• W2172068661 hasRelatedWork W2108977729 @default.
• W2172068661 hasRelatedWork W2160502551 @default.
• W2172068661 hasRelatedWork W2341835401 @default.
• W2172068661 hasRelatedWork W2883878040 @default.
• W2172068661 hasRelatedWork W2344108540 @default.
• W2172068661 hasVolume "6" @default.
• W2172068661 isParatext "false" @default.
• W2172068661 isRetracted "false" @default.
• W2172068661 magId "2172068661" @default.
• W2172068661 workType "article" @default.