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Unexpected outcome (positive or negative) including adverse drug reactions
CASE REPORT
Left ventricular mural thrombus despite treatment with dabigatran and clopidogrel
  1. Maise Fredgart,
  2. Sabine Gill
  1. Department of Cardiology, Odense Universitetshospital, Odense, Denmark
  1. Correspondence to Dr Maise Fredgart, Maise.Hoigaard.Fredgart{at}rsyd.dk

Summary

We describe a case with severe heart failure and moderate aortic stenosis. Due to previous atrial fibrillation and ischaemic heart disease, this patient was treated with both dabigatran and clopidogrel. Despite this, a large mural thrombus was found on echocardiography. The treatment was altered to warfarin, but the thrombus did not resolve during the next eight months.

Guidelines for the use of anticoagulant treatment in left ventricular thrombus are needed. Previously, a few cases presenting resistance to novel oral anticoagulants have been published and cases with thrombus formation due to dabigatran have been described. Our patient showed resistance to both dabigatran and warfarin, and there was no thrombus resolution when changing the treatment to warfarin.

  • heart failure
  • ischaemic heart disease
  • cardiovascular system

https://doi.org/10.1136/bcr-2017-223899

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    Footnotes

    • Contributors SG has treated the patient and has planned the writing of a case report. MF has written the case report and has later also treated the patient herself. Acquisition and analysis of data has been performed by SG and MF. SG has found the video and picture displaying the mural thrombus.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.