A CASE OF EFFECTIVE ANTICOAGULANT THERAPY IN A PATIENT WITH CORONARY HEART DISEASE, CHRONIC HEART FAILURE, ATRIAL FIBRILLATION, AND LEFT VENTRICULAR THROMBOSIS

Abstract

Objective: to describe effective treatment in a patient with stent thromboses and a left ventricular (LV) thrombus resistant to therapy with the novel anticoagulants clopidogrel and prasugrel. Materials and methods. Patient P.V., aged 53 years, was admitted to the Department of Cardiology with complaints of dyspnea, lower limb edema, general weakness, palpitation, reduced urine output, and elevated body temperature. His medical history showed myocardial infarction experienced three times, coronary stenting using 3 drug-eluting stents, and stent thromboses. Echocardiography (EchoCG) revealed a mobile thrombus with a total area of 11 cm2 in the area of chronic LV aneurysm. Results. According to the data of EchoCG conducted over time, there was a decrease in thrombus sizes to 3.06 cm2 during rivaroxaban therapy, their subsequent increase up to 9.25 cm2 after anticoagulant therapy that was discontinued without permission, and final lysis of a LV thrombus following the intake of rivaroxaban 20 mg/day during one month. Conclusion. LV thrombus lysis in the rivaroxaban-treated patient with post-infarction cardiosclerosis and stent thromboses resistant to therapy with clopidogrel and prasugrel was described in this case.

Keywords

• left ventricular thrombus
• stent thrombosis
• myocardial infarction
• post-infarction cardiosclerosis
• coronary stenting
• chronic heart failure
• anticoagulant therapy
• novel oral anticoagulants
• rivaroxaban
• prasugrel
• clopidogrel
• resistance to clopidogrel