Dataset Information

Novel oral anticoagulants in intracardiac thrombosis resolution: a case series.

ABSTRACT:

Background

Vitamin K antagonists (VKAs) have been regarded as the therapy of choice for intracardiac thrombosis for decades based mostly on observational data. The advent of direct oral anticoagulants (DOACs) has displaced VKAs as the first-line therapy for multiple thrombotic disorders but not for intracardiac thrombosis. Although limited, there is growing evidence that DOACs are effective for intracardiac thrombosis and some data suggest that thrombus resolution might be superior to that with warfarin.

Case summary

Here, we present a series of six patients with left atrial appendage thrombi were treated with a venous thromboembolic dose of DOACs with resolution within 2-6 months with no reported complications.

Discussion

This case series adds to the accumulating evidence supporting the efficacy of DOACs in the treatment of intracardiac thrombi.

SUBMITTER: Al-Sadawi M

PROVIDER: S-EPMC7649461 | biostudies-literature | 2020 Oct

REPOSITORIES: biostudies-literature

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Publications

Novel oral anticoagulants in intracardiac thrombosis resolution: a case series.

Al-Sadawi Mohammed M Francois Jonathan J Rodriguez Ortega Romy R Capric Violeta V Budzikowski Adam S AS

European heart journal. Case reports 20200830 5

<h4>Background</h4>Vitamin K antagonists (VKAs) have been regarded as the therapy of choice for intracardiac thrombosis for decades based mostly on observational data. The advent of direct oral anticoagulants (DOACs) has displaced VKAs as the first-line therapy for multiple thrombotic disorders but not for intracardiac thrombosis. Although limited, there is growing evidence that DOACs are effective for intracardiac thrombosis and some data suggest that thrombus resolution might be superior to th ...[more]

PMID: 33204959

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Project description:Abstract Background Prosthetic valve thrombosis (PVT) is a severe complication of mechanical valve replacement. Simultaneous thrombosis of multiple prosthetic valves is rare and is associated with worse outcomes. Treatment options include anticoagulation, thrombolysis, and redo operative valve replacement, with rare reports of adjunctive balloon valvuloplasty. There is limited evidence to guide therapeutic selection, specifically dosing, timing, and duration of thrombolysis. The following case series highlights the importance of successful thrombolytic management in dual PVT with high bleeding risk defined as a coagulopathy with an elevated international normalized ratio greater than 3 and New York Heart Association (NYHA) Class III and IV heart failure. Case summary We describe two patients with concomitant aortic and mitral PVT. Both patients presented in NYHA Class III and IV heart failure with different challenges to surgical treatments including high bleeding risk from coagulopathy and history of multiple prior sternotomies. After multi-disciplinary discussions, both patients underwent a combination of low-dose, slow, or ultra-slow infusion of tissue plasminogen activator, with a resolution of their dual PVT seen on cine-fluoroscopy imaging as freely moving mechanical leaflets and improvement of heart failure symptoms back to baseline NYHA Class II or lower. Discussion Prosthetic valve thrombosis is a complex medical condition requiring a multi-disciplinary team to evaluate the best course of treatment. A trial of pharmacologic thrombolysis is often the first attempted treatment for obstructive PVT, although surgery is recommended for patients with NYHA IV symptoms, or with contraindications to thrombolysis, including high bleeding risk. However, in patients with high bleeding risk and NYHA Class III and IV heart failure, especially with surgical contraindications, low-dose thrombolytics, with slow or ultra-slow infusions, may still be safe and effective treatment strategies for multi-valve PVT. Further research is needed to guide thrombolysis in multi-valve PVT.

Project description:Background and purposeCerebral venous thrombosis causes disability from venous infarct and hemorrhage and potential mortality. Anticoagulation improves survival and disability outcomes, yet direct oral anticoagulants are currently not indicated in cerebral venous thrombosis due to lack of evidence, despite being on the market for nearly a decade. This systematic review will collate evidence of reported safety and efficacy of direct oral anticoagulant therapy in cerebral venous thrombosis.MethodsA search strategy was developed with a research librarian and registered on a protocol database (PROSPERO CRD42017078398). All published studies from MEDLINE and EMBASE up to February 2019 containing patients diagnosed with cerebral venous thrombosis who were treated with a direct oral anticoagulant (dabigatran, rivaroxaban, apixaban, or edoxaban) will be included. A risk of bias analysis will be performed to evaluate quality of studies overall.DiscussionCurrent guidelines in the treatment of cerebral vein thrombosis dating back to 2011 from the American Heart Association/American Stroke Association endorse the utility of anticoagulation for the treatment of cerebral vein thrombosis; however, they did not support the use of direct oral anticoagulants. Updated guidelines from the European Stroke Organization, endorsed by the European Academy of Neurology in 2017, also refute utilization of direct oral anticoagulants due to a lack of evidence. There have been nearly 10 years of experience with direct oral anticoagulants in the treatment of venous thrombosis and prevention of stroke in patients with atrial fibrillation, with purported efficacy and safety in comparison with heparins and vitamin K antagonists. Our goal is to undertake a systematic review to assess the effectiveness and safety of direct oral anticoagulants in patients with cerebral vein thrombosis to help guide clinical decision-making for patients unable to take heparins or vitamin K antagonists and to direct future studies to contribute further to an area of certain evidence-based needs.Systematic review registrationPROSPERO CRD42017078398.

Dataset Information

Novel oral anticoagulants in intracardiac thrombosis resolution: a case series.

Background

Case summary

Discussion

Publications

Novel oral anticoagulants in intracardiac thrombosis resolution: a case series.

Similar Datasets

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