Medicine · 2018
Optimal nonvitamin K antagonist oral anticoagulant therapy in a warfarin-sensitive patient after left atrial appendage closure: A case report.
Клинический случайСтатьяНазвание и аннотация: Перевод в очереди
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Shen Long, Fang Sha-Sha, Ge Heng, Qiao Zhi-Qing, Gu Zhi-Chun
Аннотация
RATIONALE: Developing an optimal medication strategy poses a challenging task in fragile patients after left atrial appendage closure (LAAC). We report an optimal nonvitamin K antagonist oral anticoagulant (NOAC) therapy in a warfarin-sensitive patient after LAAC.
PATIENT CONCERNS: A 77-year-old nonvalvular atrial fibrillation (NVAF) male carrying 2 warfarin-sensitive alleles experienced 2 gum-bleeding with the international normalized ratio (INR) around 3.
DIAGNOSES: Persistent NVAF with a history of subtotal gastrectomy and moderate renal insufficiency.
INTERVENTIONS: Warfarin was discontinued and vitamin K1 was immediately administrated via intravenous infusion. LAAC was regarded as a preferable option, and rivaroxaban 15 mg daily was managed after LACC.
OUTCOMES: Complete endothelialization on the surface of device was detected via transoesophageal echocardiography (TEE), and no peridevice spillage and adverse event occurred.
LESSONS: A post-LAAC treatment with NOAC may be a viable regimen in patients intolerant to warfarin.
PATIENT CONCERNS: A 77-year-old nonvalvular atrial fibrillation (NVAF) male carrying 2 warfarin-sensitive alleles experienced 2 gum-bleeding with the international normalized ratio (INR) around 3.
DIAGNOSES: Persistent NVAF with a history of subtotal gastrectomy and moderate renal insufficiency.
INTERVENTIONS: Warfarin was discontinued and vitamin K1 was immediately administrated via intravenous infusion. LAAC was regarded as a preferable option, and rivaroxaban 15 mg daily was managed after LACC.
OUTCOMES: Complete endothelialization on the surface of device was detected via transoesophageal echocardiography (TEE), and no peridevice spillage and adverse event occurred.
LESSONS: A post-LAAC treatment with NOAC may be a viable regimen in patients intolerant to warfarin.
Предметные рубрики MeSH
AgedAnticoagulantsAtrial AppendageAtrial FibrillationCardiac Surgical ProceduresDrug-Related Side Effects and Adverse ReactionsEchocardiography, TransesophagealHumansMalePharmacogenomic TestingPostoperative CareProsthesis ImplantationRisk AdjustmentRivaroxabanSeptal Occluder DeviceTreatment OutcomeWarfarin