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Atrial Fibrillation in Intermediate CHA2DS2-Vasc Risk Group as a Cause of Thromboembolic Complications: Case Report

Grzegorz Sobieszek, Agnieszka Wójtowicz-Scislak, Bartolomeo Zerillo

Atrial Fibrillation (AF) is a common arrhythmia, especially for elderly people and it can lead to thromboembolic complications. A 42-year-old man was presented with the strong abdominal pain, radiating to the back and a fever. He had elevated troponin, NT-pro-BNP, D-dimer. Electrocardiography (ECG) showed Atrial Fibrillation (AF), and an echocardiography revealed a slight enlargement of both atria. A coronary angiography did not show significant lesions, requiring an invasive intervention. Trans-Esophageal Echocardiography (TEE) confirmed thrombus in the left auricle. An embolic material in the superior mesenteric artery and infarction of right kidney were found in Computed Tomography Angiography (CTA). Beside standard treatment of ischemic heart disease, the patient received a therapeutic dose of Low Molecular Weight Heparin (LMWH) in the acute period of disease and then the heparin was changed to Novel Oral AntiCoagulants (NOAC). Despite of a therapy two weeks later he developed the embolism of the lower limb and the infarction of the left kidney. Then the TEE did not confirm the thrombus, so electric cardioversion was performed.

According to CHA2DS2-VASc scale, the patient received 1 point, so the anticoagulation should be considered (but it was not obligatory), weighing the individual bleeding risk against the risk of stroke. It is valid to treat each patient individually and take into account thromboembolic diseases, not only in high-risk group.