American Journal of Medical Case Reports
ISSN (Print): 2374-2151 ISSN (Online): 2374-216X Website: Editor-in-chief: Samy, I. McFarlane
Open Access
Journal Browser
American Journal of Medical Case Reports. 2015, 3(5), 153-154
DOI: 10.12691/ajmcr-3-5-10
Open AccessArticle

All Target Specific Anticoagulants are not Created Equal

Mohammad Umar Farooq1, and Daniel Mascarenhas2

1Internal Medicine, Easton Hospital, Easton, Pennsylvania, USA

2Cardiovascular Disease, Easton Hospital, Easton, Pennsylvania, USA

Pub. Date: May 07, 2015

Cite this paper:
Mohammad Umar Farooq and Daniel Mascarenhas. All Target Specific Anticoagulants are not Created Equal. American Journal of Medical Case Reports. 2015; 3(5):153-154. doi: 10.12691/ajmcr-3-5-10


Background: New target specific anticoagulants (TSOACs) are convenient to use and effective management in the prophylaxis against thromboembolic sequela of atrial fibrillation (AF). However, without a test to monitor therapeutic efficacy, non-responders may not be detected until they suffer complications. We present a case where one year of dabigatran treatment failed to prevent development of a left atrial clot in the setting of AF. Case: An 84-year-old male with persistent atrial fibrillation presented with anemia of unknown etiology. Workup revealed no acute sources of bleeding, but he was on oral anticoagulation with dabigatran for greater than one year. Anticoagulation had to be discontinued for planned endoscopy. Thus, patient was electrically cardioverted to sinus rhythm. However, 3 days later he presented with a clot in the left femoral artery requiring embolectomy and was back in atrial fibrillation. He was switched to rivaroxaban for anticoagulation. Transesophageal echocardiogram (TEE) 4 weeks later revealed no clot. He was started on the antiarrhythmic amiodarone, then electrically cardioverted to sinus rhythm without complication. Discussion: TEE should be performed prior to electrical cardioversion for patients on TSOACs in case patient is a non-responder. Non-responders, should be placed on a TSOAC with an alternative mechanism of action. Conclusion: Switching TSOACs may be effective management for certain patients with failure of anticoagulation.

atrial fibrillation target specific anticoagulants novel oral anticoagulants failure of anticoagulation

Creative CommonsThis work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit


[1]  Andrade JG, Khairy P, Macle L, Packer DL, Lehmann JW, Holcomb RG, Ruskin JN, Dubuc M (2014) Incidence and significance of early recurrences of atrial fibrillation after cryoballoon ablation: insights from the multicenter Sustained Treatment of Paroxysmal Atrial Fibrillation (STOP AF) Trial. Circulation Arrhythmia and electrophysiology 7 (1):69-75.
[2]  Arepally GM, Ortel TL (2015) Changing practice of anticoagulation: will target-specific anticoagulants replace warfarin? Annu Rev Med 66:241-253.
[3]  Kazmi RS, Lwaleed BA (2011) New anticoagulants: how to deal with treatment failure and bleeding complications. British journal of clinical pharmacology 72 (4):593-603.