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      Right ventricular thrombus formation in a patient with arrhythmogenic right ventricular dysplasia following radiofrequency ablation

      case-report

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          Key Clinical Message

          A middle‐aged female suffering from ARVD presented for routine follow‐up 8 weeks after right ventricular radiofrequency ablation of recurring ventricular tachycardia. Echocardiography revealed two right ventricular thrombi in the scar area of right ventricular radiofrequency ablation. Ablation‐related thromboembolic events should be considered as possible complication in patients suffering from ARVD.

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          Efficacy and safety of apixaban compared with warfarin according to patient risk of stroke and of bleeding in atrial fibrillation: a secondary analysis of a randomised controlled trial.

          Renato D Lopes, Sana Al-Khatib, Lars Wallentin … (2012)
          The Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation (ARISTOTLE) trial showed that apixaban is better than warfarin at prevention of stroke or systemic embolism, causes less bleeding, and results in lower mortality. We assessed in this trial's participants how results differed according to patients' CHADS(2), CHA(2)DS(2)VASc, and HAS-BLED scores, used to predict the risk of stroke and bleeding. ARISTOTLE was a double-blind, randomised trial that enrolled 18,201 patients with atrial fibrillation in 39 countries. Patients were randomly assigned apixaban 5 mg twice daily (n=9120) or warfarin (target international normalised ratio 2·0-3·0; n=9081). The primary endpoint was stroke or systemic embolism. The primary safety outcome was major bleeding. We calculated CHADS(2), CHA(2)DS(2)VASc, and HAS-BLED scores of patients at randomisation. Efficacy analyses were by intention to treat, and safety analyses were of the population who received the study drug. ARISTOTLE is registered with ClinicalTrials.gov, number NCT00412984. Apixaban significantly reduced stroke or systemic embolism with no evidence of a differential effect by risk of stroke (CHADS(2) 1, 2, or ≥3, p for interaction=0·4457; or CHA(2)DS(2)VASc 1, 2, or ≥3, p for interaction=0·1210) or bleeding (HAS-BLED 0-1, 2, or ≥3, p for interaction=0·9422). Patients who received apixaban had lower rates of major bleeding than did those who received warfarin, with no difference across all score categories (CHADS(2), p for interaction=0·4018; CHA(2)DS(2)VASc, p for interaction=0·2059; HAS-BLED, p for interaction=0·7127). The relative risk reduction in intracranial bleeding tended to be greater in patients with HAS-BLED scores of 3 or higher (hazard ratio [HR] 0·22, 95% CI 0·10-0·48) than in those with HAS-BLED scores of 0-1 (HR 0·66, 0·39-1·12; p for interaction=0·0604). Because apixaban has benefits over warfarin that are consistent across patient risk of stroke and bleeding as assessed by the CHADS2, CHA2DS2VASc, and HAS-BLED scores, these scores might be less relevant when used to tailor apixaban treatment to individual patients than they are for warfarin. Further improvement in risk stratification for both stroke and bleeding is needed, particularly for patients with atrial fibrillation at low risk for these events. Bristol-Myers Squibb and Pfizer. Copyright © 2012 Elsevier Ltd. All rights reserved.
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            Thromboembolic complications in patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy.

            Elzbieta Katarzyna Wlodarska, Olgierd Wozniak, Marek Konka … (2006)
            Incidence and clinical presentation of thromboembolic complications in patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) were analysed. In reports on ARVD/C, thromboembolism is rarely mentioned. The possible risk factors are: right ventricle (RV) dilatation, aneurysms, and wall motion abnormalities.
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              Successful resolution of a left ventricular thrombus with apixaban treatment following acute myocardial infarction.

              Yoshinori Mano, Kimi Koide, Hiroaki Sukegawa … (2016)
              A 62-year-old man was admitted to our emergency department owing to prolonged chest pain that had lasted for 3 h. An electrocardiogram showed ST elevation in leads I, aVL, and V1-6, and the patient's laboratory revealed elevated myocardial necrosis marker levels. Emergency coronary angiography showed total occlusion of the proximal left anterior descending coronary artery. Subsequent percutaneous coronary intervention was performed by balloon angioplasty followed by stent implantation, and the patient showed improvement. However, echocardiographic examination 2 weeks after the percutaneous coronary intervention showed a thrombus (40 × 14 mm) in the apex of the left ventricle. In addition to dual antiplatelet therapy, apixaban was administered as anticoagulant therapy for the left ventricular thrombus. The size of the thrombus gradually decreased, and magnetic resonance imaging performed approximately 6 weeks after the initial apixaban administration showed no thrombus without a thromboembolic event. This case demonstrates that left ventricular thrombus can be resolved with apixaban treatment. Apixaban may be an effective alternative to vitamin K antagonist for some patients with acute myocardial infarction complicated by left ventricular thrombus.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Clin Case Rep
                Journal ID (iso-abbrev): Clin Case Rep
                Journal ID (doi): 10.1002/(ISSN)2050-0904
                Journal ID (publisher-id): CCR3
                Title: Clinical Case Reports
                Publisher: John Wiley and Sons Inc. (Hoboken )
                ISSN (Electronic): 2050-0904
                Publication date (Electronic): 23 April 2016
                Publication date Collection: June 2016
                Volume: 4
                Issue: 6 ( doiID: 10.1111/ccr3.2016.4.issue-6 )
                Pages: 554-557
                Affiliations
                [ 1 ] Klinik für Herz‐ und Kreislauferkrankungen Deutsches Herzzentrum MünchenTechnische Universität München MunichGermany
                [ 2 ] Department of Nephrology Klinikum rechts der IsarTechnische Universität München MunichGermany
                [ 3 ] Deutsches Zentrum für Herz‐Kreislauf‐Forschung (DZHK) e.V.Partner Site Munich Heart Alliance (MHA) MunichGermany
                Author notes
                [*] [* ] Correspondence

                Stephan Kemmner, Klinikum rechts der Isar, Ismaninger Str. 22, 81675 München, Germany. Tel: +49 (0)89 4140 6704; Fax: +49 (0)89 4140 7734; E‐mail: stephan.kemmner@ 123456tum.de

                Article
                Publisher ID: CCR3537
                DOI: 10.1002/ccr3.537
                PMC ID: 4891477
                PubMed ID: 27398195
                SO-VID: 5f8f0dc7-018c-4380-97c9-3742e68276bd
                Copyright © © 2016 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd.
                License:

                This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial‐NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

                History
                Date received : 12 November 2015
                Date revision received : 19 February 2016
                Date accepted : 24 February 2016
                Page count
                Pages: 4
                Funding
                Funded by: German Research Foundation (DFG)
                Funded by: Technische Universität München within the funding programme Open Access Publishing
                Categories
                Subject: Case Report
                Subject: Case Reports
                Custom metadata
                source-schema-version-number 2.0
                component-id ccr3537
                cover-date June 2016
                details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_NLMPMC version:4.9.1 mode:remove_FC converted:06.07.2016

                Keywords: anticoagulation,arrhythmogenic right ventricular dysplasia,radiofrequency ablation,thrombus formation,ventricular tachycardia
                Data availability:
                Keywords: anticoagulation, arrhythmogenic right ventricular dysplasia, radiofrequency ablation, thrombus formation, ventricular tachycardia

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