Two female patients (86 and 88 years) with paroxysmal atrial fibrillation (AF), hypertensive heart disease, and low ejection fraction (EF) (48 and 52%) and one male patient (82 years) with persistent AF and no underlying heart disease had thrombus in left atrial appendage (LAA) evaluated by transoesophageal echocardiography (TEE). No patients had a history of anticoagulation therapy. The size of LAA thrombus was 7 × 13, 8 × 7.5, and 14 × 12 mm2 (Figure), respectively. Dabigatran 220 mg/day was prescribed and the disappearance of thrombus evaluated by TEE was confirmed in all three patients 19, 25, and 27 days after the initiation of dabigatran treatment, respectively. No patient had thromboembolism and bleeding events from the beginning of dabigatran treatment to the disappearance of the thrombus. Dabigatran etexilate is the prodrug which is rapidly converted by tissue esterases to dabigatran, a direct thrombin inhibitor, and the anticoagulant effect begins minutes after oral ingestion and usually peaks in 2–3 h. Rapid and effective anticoagulation is required for patients with acute pre-existing atrial thrombi to avoid a thromboembolism. In conclusion, dabigatran is useful in patients with acute pre-existing atrial thrombus because of its thrombolytic action.
The full-length version of this report can be viewed at: http://www.escardio.org/communities/EHRA/publications/ep-case-reports/Documents/thrombolytic-action-of-dabigatran.pdf
