Rinsho Shinkeigaku (Clinical Neurology)

Case Report

A case of cardiogenic embolism, which occurred under appropriate warfarin use, treated with thoracoscopic left atrial appendectomy

Muneaki Kikuno, M.D.1), Masatoshi Koga, M.D., Ph.D.2), Yuta Kume, M.D.3), Toshiya Ohtsuka, M.D., Ph.D.4), Mikito Hayakawa, M.D.1) and Kazunori Toyoda, M.D., Ph.D.1)

1)Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center
2)Department of Stroke Care Unit, National Cerebral and Cardiovascular Center
3)Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
4)Department of Cardiovascular Surgery, Tama Metropolitan Medical Center

A 74-year-old man with a past medical history of bradycardiac atrial fibrillation and an old cerebral infarction presented with dysarthria. He had been treated with warfarin and PT-INR on admission was 2.0. MRI of the head revealed an acute ischemic stroke involving the cerebellum and left occipital lobe. Because transesophageal cardiac echography showed a thrombus in the left atrial appendage, anticoagulant treatment with warfarin and heparin was initiated. The thrombus was enlarging; therefore, we changed the anticoagulant therapy to apixaban with heparin on day 11. On day 17, a hemorrhagic cerebral infarction occurred. After the hemorrhage diminished, we treated him with warfarin aiming for a PT-INR between 3 and 4. The thrombus gradually shrank and disappeared on day 110. Finally, a thoracoscopic left atrial appendectomy was performed as a secondary prevention, with no recurrence till date.
Full Text of this Article in Japanese PDF (1773K)

(CLINICA NEUROL, 58: 9|14, 2018)
key words: nonvalvular atrial fibrillation, left atrial appendage thrombus, anticoagulant therapy, thoracoscopic left atrial appendectomy

(Received: 31-May-17)