Optimal nonvitamin K antagonist oral anticoagulant therapy in a warfarin-sensitive patient after left atrial appendage closure: A case report.

ABSTRACT: RATIONALE:Developing an optimal medication strategy poses a challenging task in fragile patients after left atrial appendage closure (LAAC). We report an optimal nonvitamin K antagonist oral anticoagulant (NOAC) therapy in a warfarin-sensitive patient after LAAC. PATIENT CONCERNS:A 77-year-old nonvalvular atrial fibrillation (NVAF) male carrying 2 warfarin-sensitive alleles experienced 2 gum-bleeding with the international normalized ratio (INR) around 3. DIAGNOSES:Persistent NVAF with a history of subtotal gastrectomy and moderate renal insufficiency. INTERVENTIONS:Warfarin was discontinued and vitamin K1 was immediately administrated via intravenous infusion. LAAC was regarded as a preferable option, and rivaroxaban 15?mg daily was managed after LACC. OUTCOMES:Complete endothelialization on the surface of device was detected via transoesophageal echocardiography (TEE), and no peridevice spillage and adverse event occurred. LESSONS:A post-LAAC treatment with NOAC may be a viable regimen in patients intolerant to warfarin.

SUBMITTER: Shen L 

PROVIDER: S-EPMC6392999 | biostudies-literature | 2018 May

REPOSITORIES: biostudies-literature