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• Vol.58 No.1
• CLINICA NEUROL, 58: 9−14, 2018
• Vol.58 No.1 contents

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)