title: Increase in the Size of an Intracardiac Thrombus during Dabigatran Therapy (110 mg b.i.d.) in an Acute Cardioembolic Stroke Patient.
abstract: We report a case of atrial fibrillation in a patient in whom a mobile thrombus in the left atrial appendage increased in size after low-dose dabigatran therapy. A 74-year-old man was admitted to our hospital because of sudden onset of right hemiplasia and dysarthria. On admission, his National Institutes of Health Stroke Scale score was three. Axial diffusion-weighted magnetic resonance images and magnetic resonance angiography images showed hyperintense signals in the left front-parietal cerebral cortex without any intracranial stenotic lesions, and acute cardioembolic stroke associated with nonvalvular atrial fibrillation was diagnosed. Transesophageal echocardiography revealed a mobile thrombosis (1.0 × 2.2 cm) in the left atrial appendage, and dabigatran therapy (110 mg b.i.d.) was initiated to prevent stroke recurrence. Transesophageal echocardiography performed 6 days later revealed that the size of the thrombus had increased to 1.5 × 3.0 cm. Medication was changed to warfarin, and the thrombosis subsequently decreased in size. The patient did not have a recurrent stroke and was discharged with a National Institutes of Health Stroke Scale score of zero. This case demonstrates that low-dose dabigatran may not be effective in reducing the size of a thrombus.
authors.affiliation: Department of Cerebrovascular Medicine and Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukukuoka, Japan.
authors.forename: Emi
authors.initials: E
authors.lastname: Tabata
authors.forename: Masahiro
authors.initials: M
authors.lastname: Yasaka
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Wakugawa
authors.forename: Motohiro
authors.initials: M
authors.lastname: Komori
authors.forename: Kohta
authors.initials: K
authors.lastname: Mori
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Tsurusaki
authors.forename: Kazuhito
authors.initials: K
authors.lastname: Kokuba
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Sambongi
authors.forename: Koichiro
authors.initials: K
authors.lastname: Maeda
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Okada
keywords: Acute cardioembolic stroke; Dabigatran; Intracardiac thrombus; Nonvalvular atrial fibrillation; Transesophageal echocardiography