Fatal freely mobile left atrial thrombus: fallout of anticoagulation?
Rheumatic heart disease with moderate mitral stenosis and a large left atrial (LA) thrombus was diagnosed in a 45-year-old woman at a peripheral hospital. Oral anticoagulation was administered, and the patient was referred for further management. During the intervening period, sudden worsening of dyspnea developed in the patient and a repeat echocardiogram revealed a large thrombus freely vacillating within the left atrium. Urgent open mitral valvotomy and LA thrombus removal were planned. However, as the patient was being prepared for surgery, she had a fatal cardiorespiratory arrest and could not be revived. Warfarin is known to influence thrombus lysis, and it is possible that it may have severed the LA thrombus from the posterior LA wall by partially lysing it, leading to the formation of a ball-valve thrombus, which is a well-known risk factor for sudden death.
Roy
Ambuj
A
Department of Cardiology, Cardiothoracic Center, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India. drambujroy@gmail.com
Naik
Nitish
N
Nagesh
Chamarajnagar M
CM
Saxena
Anita
A
D000925:Anticoagulants / Q000009:adverse effects* / Q000627:therapeutic use*; D017809:Fatal Outcome; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging*; D006801:Humans; D008875:Middle Aged; D008946:Mitral Valve Stenosis / Q000139:chemically induced* / Q000000981:diagnostic imaging*; D013927:Thrombosis / Q000150:complications / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D014463:Ultrasonography
D000925:Anticoagulants