title: Left atrial appendage thrombus with resulting stroke post-RF ablation for atrial fibrillation in a patient on dabigatran.
abstract: Dabigatran etexilate is licensed for use in prevention of deep venous thromboembolism and in prevention of stroke and systemic embolism in nonvalvular atrial fibrillation (AF). It has also been used in patients for other indications as a substitute for warfarin therapy because it requires no monitoring; one group being patients undergoing radiofrequency (RF), ablation for AF, although there have been no consensus guidelines with regards to dosage and timing of dose. We report the case of a patient with documentary evidence of left atrial appendage (LAA) thrombus formation and neurological sequelae post-RF ablation despite being on dabigatran. This case highlights the concern that periprocedural dabigatran may not provide adequate protection from development of LAA thrombus and that a standardised protocol will need to be developed and undergo large multicentre trials before dabigatran can be safely used for patients undergoing RF-ablation.
authors.affiliation: University Hospital Limerick, Dooradoyle, Co Limerick. DoctorRLobo@gmail.com
authors.forename: R
authors.initials: R
authors.lastname: Lobo
authors.forename: C
authors.initials: C
authors.lastname: McCann
authors.forename: A
authors.initials: A
authors.lastname: Hussaini
authors.forename: T B
authors.initials: TB
authors.lastname: Meany
authors.forename: T J
authors.initials: TJ
authors.lastname: Kiernan
mesh_terms: D000991:Antithrombins / Q000008:administration & dosage* / Q000009:adverse effects; D020517:Atrial Appendage / Q000000981:diagnostic imaging / Q000473:pathology; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D001562:Benzimidazoles / Q000008:administration & dosage* / Q000009:adverse effects; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods*; D003328:Coronary Thrombosis / Q000175:diagnosis* / Q000000981:diagnostic imaging; D000069604:Dabigatran; D004347:Drug Interactions; D005260:Female; D006801:Humans; D008875:Middle Aged; D020521:Stroke / Q000188:drug therapy / Q000209:etiology* / Q000517:prevention & control; D014463:Ultrasonography; D015091:beta-Alanine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*
chemical_list: D000991:Antithrombins; D001562:Benzimidazoles; D015091:beta-Alanine; D000069604:Dabigatran