title: Acute left atrial thrombosis during anticoagulant therapy in a patient with antithrombin deficiency.
abstract: A 47-year-old woman presented to our clinic 1 day after an intervention for a tibial shaft fracture because of sudden onset of chest pain and palpitations. Hospital drug therapy included enoxaparin. The ECG showed atrial fibrillation with a rapid ventricular rate. Transthoracic echocardiography showed a mass in the LA. Transoesophageal echocardiography (TEE) was performed which showed a multilobulated liquid-filled mass (3.6 x 3.7 cm), adherent to the septal, anterior and posterolateral LA most consistent with thrombosis. Tests for hypercoagulable disorders revealed antithrombin deficiency (antithrombin-heparin co-factor level = 30% [normal pooled plasma activity 70%-140%]), suggesting that it played an outstanding role in the LA thrombosis. After initial stabilization, the patient was discharged with warfarin (target INR = 2.5-3.5) together with beta-blockers, statins and metformin. After 1 month of follow-up the patient underwent TEE which showed a dramatic reduction of the left atrial thrombosis. Our patient is doing well and is continuing life-long anticoagulant therapy.
authors.affiliation: Istituto di Cardiologia, Università Cattolica del Sacro Cuore, Rome, Italy. pasquale.santangeli@libero.it
authors.forename: Pasquale
authors.initials: P
authors.lastname: Santangeli
authors.forename: Alfonso
authors.initials: A
authors.lastname: Sestito
mesh_terms: D000208:Acute Disease; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects*; D020152:Antithrombin III Deficiency / Q000188:drug therapy*; D001281:Atrial Fibrillation / Q000209:etiology*; D017548:Echocardiography, Transesophageal; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000473:pathology*; D006801:Humans; D008875:Middle Aged; D013923:Thromboembolism / Q000139:chemically induced* / Q000150:complications / Q000000981:diagnostic imaging / Q000209:etiology
chemical_list: D000925:Anticoagulants