title: Thrombus in acute aortic dissection with atrial fibrillation: a treatment dilemma.
abstract: Type B acute aortic dissection (AAD) is often successfully managed with medical therapy, with a lower mortality rate, compared with type A AAD. Although the number of AAD patients complicated with atrial fibrillation (AF) has increased, reflecting an aging society, there have only been a few reports regarding the association of AAD and AF. Furthermore, there is no consensus on anticoagulation therapy in ADD patients complicated with AF, despite the importance of anticoagulation therapy in AF treatment. Here, we discuss a 79-year-old man with type B AAD and chronic AF complicated with the rapid left atrial appendage (LAA) thrombus formation after discontinuation of anticoagulation therapy. Emergent contrast-enhanced computed tomography revealed type B AAD with a partially thrombosed false lumen from the bifurcation of the aorta and the left subclavian artery to above the diaphragm. Ulcer-like projection was observed in the proximal thrombosed false lumen. Ten days after discontinuation of anticoagulation therapy, LAA thrombus was detected on contrast-enhanced computed tomography, which was not observed on admission. After anticoagulation therapy was resumed, the LAA thrombus disappeared,but the partially thrombosed false lumen was enlarged. The second discontinuation of anticoagulation therapy stabilized the dissected aorta and did not cause recurrence of LAA thrombus. In conclusion,clinicians need to balance the prevention of LAA thrombus formation with the complete thrombosis of a false lumen in patients with AAD and AF.
authors.affiliation: Division of Cardiology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan. Electronic address: yshiraishi@a3.keio.jp.
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Shiraishi
authors.affiliation: Division of Cardiology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Kohno
authors.affiliation: Division of Cardiology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Toru
authors.initials: T
authors.lastname: Egashira
authors.affiliation: Division of Cardiology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Maekawa
authors.affiliation: Department of Diagnostic Radiology, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Yoshitake
authors.initials: Y
authors.lastname: Yamada
authors.affiliation: Division of Cardiovascular Surgery, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Akihiro
authors.initials: A
authors.lastname: Yoshitake
authors.affiliation: Division of Cardiovascular Surgery, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Shimizu
authors.affiliation: Division of Cardiology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Motoaki
authors.initials: M
authors.lastname: Sano
authors.affiliation: Department of Diagnostic Radiology, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Jinzaki
authors.affiliation: Division of Cardiology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Keiichi
authors.initials: K
authors.lastname: Fukuda
mesh_terms: D000368:Aged; D000784:Aortic Dissection / Q000150:complications* / Q000000981:diagnostic imaging; D000925:Anticoagulants / Q000627:therapeutic use; D001014:Aortic Aneurysm / Q000150:complications* / Q000000981:diagnostic imaging; D001018:Aortic Diseases / Q000150:complications* / Q000188:drug therapy; D001281:Atrial Fibrillation / Q000150:complications*; D006801:Humans; D008297:Male; D013927:Thrombosis / Q000150:complications* / Q000188:drug therapy; D014057:Tomography, X-Ray Computed
chemical_list: D000925:Anticoagulants