A Case of Superior Mesenteric Artery Occlusion Caused by Delayed Administration of Anticoagulants in a Patient with Nonvalvular Atrial Fibrillation.

A 86-year-old female with nonvalvular atrial fibrillation (NOVAF) who did not receive prophylactic anticoagulant treatment visited our hospital because of gastrointestinal symptoms. At first, acute gastroenteritis was suspected, but later she developed ileus and she was diagnosed with superior mesenteric artery occlusion (SMAO). We successfully performed the anesthetic management of this patient and subtotal resection of the small intestine was performed. Heparin was initiated after surgery, but she developed cerebral infarction later, and finally she died due to infection and anemia caused by melena. Although this patient was at high risk of thrombosis, she did not receive anticoagulant treatment. It might result in developing SMAO, and once SMAO occurred, thrombosis recurred even on anticoagulant treatment. This case suggested the importance of primary prevention of thrombosis in patients with NVAF.