rpcardioRational Pharmacotherapy in CardiologyРациональная Фармакотерапия в Кардиологии1819-64462225-3653«SILICEA-POLIGRAF» LLC10.20996/1819-6446-2018-14-3-350-355rpcardio-1689Research ArticleNOTES FROM PRACTICEКЛИНИЧЕСКИЙ ОПЫТTHROMBOSIS OF LEFT ATRIAL APPENDAGE DURING THERAPY WITH DIRECT ORAL ANTICOAGULANT. CLINICAL CASEКЛИНИЧЕСКОЕ НАБЛЮДЕНИЕ ТРОМБОЗА УШКА ЛЕВОГО ПРЕДСЕРДИЯ, ВОЗНИКШЕГО НА ФОНЕ ТЕРАПИИ ПРЯМЫМ ПЕРОРАЛЬНЫМ АНТИКОАГУЛЯНТОМДаабульИ. С.DaaboulI. S.

аспирант, кафедра факультетской терапии №1 лечебного факультета,

119991, Москва, ул. Трубецкая, 8 стр. 2

MD, Post-Graduate Student, Chair of Faculty Therapy №1, Medical Faculty,

Trubetskaya ul. 8-2, Moscow, 119991

КоролеваС. Ю.KorolevaS. Yu.

слушатель Школы мастерства по терапии, студентка 6 курса,

119991, Москва, ул. Трубецкая, 8 стр. 2

6-th Year Student,

Trubetskaya ul. 8-2, Moscow, 119991

КудрявцеваА. А.KudrjavtsevaA. A.

слушатель Школы мастерства по терапии, студентка 6 курса, 

119991, Москва, ул. Трубецкая, 8 стр. 2

6-th Year Student,

Trubetskaya ul. 8-2, Moscow, 119991

СоколоваА. А.SokolovaA. A.

к.м.н., ассистент, кафедра факультетской терапии №1 лечебного факультета,

119991, Москва, ул. Трубецкая, 8 стр. 2

MD, PhD, Assistant, Chair of Faculty Therapy №1, Medical Faculty, 

Trubetskaya ul. 8-2, Moscow, 119991

НапалковД. А.NapalkovD. A.

д.м.н., профессор, кафедра факультетской терапии №1 лечебного факультета,

119991, Москва, ул. Трубецкая, 8 стр. 2

MD, PhD, Professor, Chair of Faculty Therapy №1, Medical Faculty,

Trubetskaya ul. 8-2, Moscow, 119991

dminap@mail.ruФоминВ. В.FominV. V.

д.м.н., профессор, член-корр. РАН, зав. кафедрой факультетской терапии №1 лечебного факультета,

119991, Москва, ул. Трубецкая, 8 стр. 2

MD, PhD, Professor, Corresponding Member of the Russian Academy of Sciences, Head of Chair of Faculty Therapy №1, Medical Faculty,

Trubetskaya ul. 8-2, Moscow, 119991

Первый Московский государственный медицинский университет им. И. М. Сеченова (Сеченовский Университет)РоссияI.M. Sechenov First Moscow State Medical University (Sechenov University)Russian Federation201804072018143350355Copyright © Daaboul I.S., Koroleva S.Y., Kudrjavtseva A.A., Sokolova A.A., Napalkov D.A., Fomin V.V., 20182018Даабуль И.С., Королева С.Ю., Кудрявцева А.А., Соколова А.А., Напалков Д.А., Фомин В.В.Daaboul I.S., Koroleva S.Y., Kudrjavtseva A.A., Sokolova A.A., Napalkov D.A., Fomin V.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.rpcardio.online/jour/article/view/1689

The article presents a clinical observation of the left atrial appendage thrombosis in a 51-year-old female patient with a paroxysmal form of nonvalvular atrial fibrillation which occurred despite long-term anticoagulant therapy with apixaban in a full dose (5 mg b.i.d.), and the patient’s management. The patient was admitted with recurrent symptomatic paroxysm for more than 48 hours, because of which, in accordance with the recommendations, transesophageal echocardiography was performed before an emergency rhythm restoration. Thrombus in the left atrial appendage 0.5×1.03 cm in size was detected. It was decided to refrain from the immediate restoration of the rhythm due to the very high risk of thromboembolic complications. In connection with the categorical refusal of the patient from warfarin, it was decided to replace apixaban with another direct oral anticoagulant – dabigatran 150 mg bid for a period of 4 weeks followed by performing a control transesophageal echocardiographic study. As a result, no thrombus was found on control echocardiography. The particularity of this observation is concomitant hypertrophic cardiomyopathy and diabetes mellitus type 1 in this patient.

В статье описывается клиническое наблюдение тромбоза ушка левого предсердия у пациентки 51 года с пароксизмальной формой неклапанной фибрилляции предсердий, возникшего на фоне длительной антикоагулянтной терапии апиксабаном в полной дозе (5 мг 2 р/сут), и тактика ведения больной. Пациентка поступила с очередным симптомным пароксизмом длительностью более 48 ч, в связи с чем, в соответствии с рекомендациями, перед экстренным восстановлением ритма была выполнена чреспищеводная эхокардиография, и выявлен тромб в ушке левого предсердия размерами 0,5×1,03 см. От немедленного восстановления ритма решено было воздержаться вследствие очень высокого риска возникновения тромбоэмболических осложнений. В связи с категорическим отказом пациентки от приема варфарина было принято решение назначить другой препарат из группы прямых пероральных антикоагулянтов – дабигатран в дозе 150 мг 2 р/сут сроком на 4 нед с последующим выполнением контрольного чреспищеводного эхокардиографического исследования. В результате было отмечено растворение тромба. Особенностью данного наблюдения является наличие у больной сопутствующих гипертрофической кардиомиопатии и сахарного диабета 1 типа.

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The authors declare that there are no conflicts of interest present.