Acute Ischemic Stroke Following Cardioversion in a Patient Receiving Dabigatran

Abstract

Novel oral anticoagulants are attractive options for anticoagulation required with cardioversion. Although this case report may not preclude use of dabigatran for this purpose, it illustrates that use of this drug is not without risks. Additional investigation into the pro-inflammatory nature of the oral direct thrombin inhibitors is needed.

Left atrial thrombus formation and resolution during dabigatran therapy: A Japanese Heart Rhythm Society report

“…Although Dabi appears to be an effective alternative to warfarin in preventing stroke or systemic embolism without requiring PT–INR monitoring, the fact that 4% of patients receiving Dabi still had LA thrombus in our survey suggests that TEE is useful when performed before elective ECV of persistent AF. Thrombus may develop even under Dabi treatment in the presence of mechanical heart valves or rheumatic mitral stenosis [12,13], but a few cases of failure to prevent LA thrombus formation with the use of this agent have also been reported in patients with AF without such backgrounds [14–16]. Although it is hard to prove, we speculate that not only higher CHADS 2 scores, but also the insufficient Dabi dosage given to some of our patients might have led to inadequate anticoagulation and subsequent clot formation.…”

Direct Oral Anticoagulants in Cardioversion: A Review of Current Evidence

“…There are a few case reports of LAA and coronary embolization with dabigatran, including 1 patient who suffered ischemic stroke after a second cardioversion attempt. 44 Two other patients who suffered embolic sequelae received dabigatran in the presence of significant valvular disease 45 or off-label dosing (110 mg). 46 These case reports further emphasize careful consideration of medical history and dosing pericardioversion use; however, they do not provide sufficient evidence to discourage dabigatran use pericardioversion.…”