Left Atrial Thrombus in Rheumatic Mitral Stenosis: A Case of Therapeutic International Normalized Ratio Failure.
Publication/Presentation Date
9-3-2025
Abstract
BACKGROUND: Atrial fibrillation or flutter in rheumatic mitral stenosis (MS) increases left atrial appendage (LAA) thrombus risk despite therapeutic anticoagulation.
CASE SUMMARY: A 72-year-old woman on warfarin with moderate MS and atrial flutter presented with dyspnea. Transesophageal echocardiogram (TEE) showed a large LAA thrombus despite an international normalized ratio >2.5. Cardioversion was deferred, and the international normalized ratio target was raised to a range of 2.5 to 3.5.
TAKE-HOME MESSAGES: While cardioversion can be considered in patients with uninterrupted anticoagulation without TEE, those with rheumatic MS are at high risk of LAA and LA thrombus and should undergo TEE before the procedure. Further research is needed to explore whether LAA thrombus warrants surgical intervention for rheumatic MS.
Volume
30
Issue
26
First Page
104884
Last Page
104884
ISSN
2666-0849
Published In/Presented At
Sabri, M. S., Weber, C., Belkadi, Y., Haas, D., & Rajeswaran, Y. (2025). Left Atrial Thrombus in Rheumatic Mitral Stenosis: A Case of Therapeutic International Normalized Ratio Failure. JACC. Case reports, 30(26), 104884. https://doi.org/10.1016/j.jaccas.2025.104884
Disciplines
Medicine and Health Sciences
PubMedID
40912841
Department(s)
Department of Medicine, Cardiology Division, Fellows and Residents
Document Type
Article