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Vol 19 (2024): Continuous Publishing
Case report
Published online: 2024-05-24

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Serious consequences of recklessly withholding anticoagulant therapy

Klaudia Katarzyna Mickiewicz1, Monika Oleksiuk-Bójko1, Kacper Orzeł1, Tycińska Agnieszka1, Anna Lisowska1, Małgorzata Knapp1
DOI: 10.5603/fc.97790

Abstract

A case report concerns a 24-year-old man after implantation of a mechanical aortic valve prosthesis (Sorin Bicarbon 23) four years ago, who reported to the Department because of sudden pain in the interscapular area and shortness of breath. Four days before admission, the patient independently discontinued warfarin anticoagulant therapy while awaiting a dental procedure. During the diagnostics, the presence of ballot thrombi attached to the ends of the prosthesis discs was found in the LVOT. The patient was treated with an infusion of unfractionated heparin. Despite this, an increase in the concentration of high-sensitivity troponin, a decrease in LVEF, and new segmental contractility disorders were observed. Angio-CT of the coronary arteries showed the presence of an LCX stenotic thrombus. After consultation with the Heart Team, conservative treatment of ACS was implemented — double antiplatelet therapy (DAPT) and VKA. The follow-up studies showed an improvement in LVEF and a reduction of echoes in the LVOT.

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