open access

Vol 11, No 5 (2016)
Case report
Published online: 2016-09-15
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Administration of oral anticoagulants in periprocedural complications based on case report series

Agata Tymińska, Krzysztof Ozierański, Paweł Balsam, Michał Peller, Piotr Lodziński, Marcin Grabowski, Grzegorz Opolski
DOI: 10.5603/FC.a2016.0086
·
Folia Cardiologica 2016;11(5):455-461.

open access

Vol 11, No 5 (2016)
Case Reports
Published online: 2016-09-15

Abstract

The use of dabigatran, a non-vitamin K antagonist (VKA) oral anticoagulant, is still increasing. Dabigatran has a good efficacy and safety ratio, as well as a more predictable anticoagulation effect compared with VKA. On the other hand, there is acenocoumarol/warfarin, a VKA which was evaluated in numerous clinical trials and is a drug of choice in a valve-related atrial fibrillation (AF).
Based on the real clinical cases, we attempted to summarize current recommendations on how to manage periprocedural complications on oral anticoagulant treatment.
In the first case we presented a patient on dabigatran, undergoing pulmonary vein isolation (PVI) of AF, who developed a right groin hematoma after the procedure and hence required several blood transfusions. In the second case we showed a patient on acenocoumarol, with high bleeding risk, who developed a pocket hematoma after an implantable cardioverter-defibrillator (ICD) implantation. We also reported a patient on dabigatran, who developed a femoral artery pseudoaneurysm (FAP) following PVI of AF.
Periprocedural oral anticoagulation depends on the anticoagulant type and requires individual assessment of the
patient’s thromboembolic and bleeding risk factors. Our case reports showed that in case of a bleeding, dabigatran
may be quickly stopped and then restarted recently after reaching hemostasis, in contrast to acenocoumarol. They also confirm a possibility of successful pseudoaneurysm closure without dabigatran suspension.

Abstract

The use of dabigatran, a non-vitamin K antagonist (VKA) oral anticoagulant, is still increasing. Dabigatran has a good efficacy and safety ratio, as well as a more predictable anticoagulation effect compared with VKA. On the other hand, there is acenocoumarol/warfarin, a VKA which was evaluated in numerous clinical trials and is a drug of choice in a valve-related atrial fibrillation (AF).
Based on the real clinical cases, we attempted to summarize current recommendations on how to manage periprocedural complications on oral anticoagulant treatment.
In the first case we presented a patient on dabigatran, undergoing pulmonary vein isolation (PVI) of AF, who developed a right groin hematoma after the procedure and hence required several blood transfusions. In the second case we showed a patient on acenocoumarol, with high bleeding risk, who developed a pocket hematoma after an implantable cardioverter-defibrillator (ICD) implantation. We also reported a patient on dabigatran, who developed a femoral artery pseudoaneurysm (FAP) following PVI of AF.
Periprocedural oral anticoagulation depends on the anticoagulant type and requires individual assessment of the
patient’s thromboembolic and bleeding risk factors. Our case reports showed that in case of a bleeding, dabigatran
may be quickly stopped and then restarted recently after reaching hemostasis, in contrast to acenocoumarol. They also confirm a possibility of successful pseudoaneurysm closure without dabigatran suspension.

Get Citation

Keywords

acenocoumarol, dabigatran, hematoma, periprocedural complications, pulmonary vein isolation, implantable cardioverter-defibrillator, pseudoaneurysm

About this article
Title

Administration of oral anticoagulants in periprocedural complications based on case report series

Journal

Folia Cardiologica

Issue

Vol 11, No 5 (2016)

Article type

Case report

Pages

455-461

Published online

2016-09-15

DOI

10.5603/FC.a2016.0086

Bibliographic record

Folia Cardiologica 2016;11(5):455-461.

Keywords

acenocoumarol
dabigatran
hematoma
periprocedural complications
pulmonary vein isolation
implantable cardioverter-defibrillator
pseudoaneurysm

Authors

Agata Tymińska
Krzysztof Ozierański
Paweł Balsam
Michał Peller
Piotr Lodziński
Marcin Grabowski
Grzegorz Opolski

References (10)
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