日本小児循環器学会雑誌 Pediatric Cardiology and Cardiac Surgery

Online ISSN: 2187-2988 Print ISSN: 0911-1794
特定非営利活動法人日本小児循環器学会 Japanese Society of Pediatric Cardiology and Cardiac Surgery
〒162-0801東京都新宿区山吹町358-5アカデミーセンター Japanese Society of Pediatric Cardiology and Cardiac Surgery Academy Center, 358-5 Yamabuki-cho, Shinju-ku, Tokyo 162-0801, Japan
Pediatric Cardiology and Cardiac Surgery 32(4): 323-327 (2016)
doi:10.9794/jspccs.32.323

症例報告Case Report

ダビガトランで右室内血栓が消失した不整脈原性右室心筋症の1例Dissolution of a Right Ventricular Thrombus with Dabigatran Etexilate in Arrhythmogenic Right Ventricular Cardiomyopathy

1大垣市民病院小児循環器新生児科Department of Pediatric Cardiology and Neonatology, Ogaki Municipal Hospital ◇ Gifu, Japan

2愛知県済生会リハビリテーション病院Aichi Saiseikai Rehabilitation Hospital ◇ Aichi, Japan

受付日:2016年2月17日Received: February 17, 2016
受理日:2016年5月13日Accepted: May 13, 2016
発行日:2016年7月1日Published: July 1, 2016
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不整脈原性右室心筋症(Arrhythmogenic right ventricular cardiomyopathy: ARVC)は,心内血栓を生じることがある.ワーファリン治療の場合が多く,新規経口抗凝固薬(Novel oral anticoagulants: NOAC)による治療の報告は少ない.症例は30歳男性で,15歳時にARVCと診断され,16歳時より心不全治療のためカルベジロール,エナラプリルの内服を開始した.30歳時の外来受診時の心臓超音波検査で右心室内血栓を認めた.ワーファリンと未分画ヘパリンを開始したが,血栓の大きさは変わらなかった.第3病日にダビガトラン300 mg/日へ変更し,5週後に血栓は消失した.ARVCの心内血栓治療にダビガトランが有用である可能性がある.また,適切な抗凝固療法により血栓塞栓症や突然死などの重大な合併症を予防できる.

Intracardiac thrombosis may occur in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC). Most thrombi are treated with warfarin, but some are treated with novel oral anticoagulants (NOAC). We describe a case of a 30-year-old man with a thrombus that was successfully dissolved by treatment with dabigatran etexilate. The patient was diagnosed with ARVC at the age of 15 years. At the age of 16, he was prescribed carvedilol and enalapril for the treatment of heart failure. However, at the age of 30, echocardiography detected a thrombus in the right ventricle. Although oral warfarin and intravenous unfractionated heparin were initiated, the size of the thrombus did not change, and on day 3 of therapy initiation, we switched from warfarin to dabigatran etexilate. On day 35, the thrombus was eliminated. Dabigatran etexilate may be effective in the treatment of intracardiac thrombosis in patients with ARVC. Adequate anticoagulation is needed to prevent severe complications such as thromboembolism or sudden death.

Key words: arrhythmogenic right ventricular cardiomyopathy; thrombosis; dabigatran etexilate; novel oral anticoagulants; anticoagulation

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