Contributions
Abstract: PB1825
Type: Publication Only
Session title: Thrombosis and vascular biology - Biology & Translational Research
Background
Atrial fibrillation (AF) is the most common arrhythmia and can result in adverse consequences of reduced cardiac output or formation of atrial thrombus. AF-related systemic thromboembolic events are the leading cause of mortality and morbidity in AF patients. Thus patients are placed on anticoagulants after risk stratification.
Aims
We present an unusual case of a 78-year old male with Stage IV pancreatic cancer and underlying AF who was found to have bi-atrial thrombi while on warfarin therapy.
Methods
Case report with information extracted from patient chart per CARE (CAse REport) guidelines
Results
CT abdomen and pelvis for routine surveillance revealed small thrombi within the right atrium and left atrial appendage, which was new compared to his most recent CT imaging performed 3 months prior. At the time of imaging, the patient was noted to have supra-therapeutic prothrombin time-international normalized ratio(PT-INR) of 3.3. The patient was admitted and initiated on unfractionated heparin infusion. He declined transitioning to low molecular weight heparin therapy as this regimen required daily subcutaneous injections. He was instead discharged home on apixaban.
Conclusion
Pancreatic cancer is associated with a hypercoagulable state; the development of thrombi despite being on anticoagulation highlights the significance of clinical awareness of thromboembolism in patients with cancer regardless of therapeutic warfarin anticoagulation. The choice of an ideal anticoagulant in patients with concomitant AF and cancer remains a controversy. Traditionally, warfarin has been the mainstay of anticoagulation therapy for stroke and systemic thromboembolism prevention in patients with AF. However, our case of failed anticoagulation with warfarin suggests that this agent may be a less ideal choice in patients with underlying malignancy, particularly in the setting of hepatic dysfunction. Recent clinical evidence suggests that a number of direct oral anticoagulants (DOACs) can effectively prevent thrombotic events with comparable safety index in cancer patients to conventional therapy. Prudent consideration of multidisciplinary factors (thrombotic and bleeding risk, drug-drug interactions, patient’s renal and hepatic function, nutritional status, patient preferences) is required in order to deliver individualised, safe, and effective anticoagulation therapy.
Keyword(s): Hypercoagulation, Thromboembolism, Warfarin
Abstract: PB1825
Type: Publication Only
Session title: Thrombosis and vascular biology - Biology & Translational Research
Background
Atrial fibrillation (AF) is the most common arrhythmia and can result in adverse consequences of reduced cardiac output or formation of atrial thrombus. AF-related systemic thromboembolic events are the leading cause of mortality and morbidity in AF patients. Thus patients are placed on anticoagulants after risk stratification.
Aims
We present an unusual case of a 78-year old male with Stage IV pancreatic cancer and underlying AF who was found to have bi-atrial thrombi while on warfarin therapy.
Methods
Case report with information extracted from patient chart per CARE (CAse REport) guidelines
Results
CT abdomen and pelvis for routine surveillance revealed small thrombi within the right atrium and left atrial appendage, which was new compared to his most recent CT imaging performed 3 months prior. At the time of imaging, the patient was noted to have supra-therapeutic prothrombin time-international normalized ratio(PT-INR) of 3.3. The patient was admitted and initiated on unfractionated heparin infusion. He declined transitioning to low molecular weight heparin therapy as this regimen required daily subcutaneous injections. He was instead discharged home on apixaban.
Conclusion
Pancreatic cancer is associated with a hypercoagulable state; the development of thrombi despite being on anticoagulation highlights the significance of clinical awareness of thromboembolism in patients with cancer regardless of therapeutic warfarin anticoagulation. The choice of an ideal anticoagulant in patients with concomitant AF and cancer remains a controversy. Traditionally, warfarin has been the mainstay of anticoagulation therapy for stroke and systemic thromboembolism prevention in patients with AF. However, our case of failed anticoagulation with warfarin suggests that this agent may be a less ideal choice in patients with underlying malignancy, particularly in the setting of hepatic dysfunction. Recent clinical evidence suggests that a number of direct oral anticoagulants (DOACs) can effectively prevent thrombotic events with comparable safety index in cancer patients to conventional therapy. Prudent consideration of multidisciplinary factors (thrombotic and bleeding risk, drug-drug interactions, patient’s renal and hepatic function, nutritional status, patient preferences) is required in order to deliver individualised, safe, and effective anticoagulation therapy.
Keyword(s): Hypercoagulation, Thromboembolism, Warfarin