ArticleCureus2025
Optimal Anticoagulation for Massive Left Atrial Appendage Thrombus in Atrial Fibrillation With a History of Gastrointestinal Bleeding.
Article in Cureus, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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0 citing papers in PubMed.
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Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Systemic embolism is a serious complication of atrial fibrillation (AF), most commonly originating from thrombi in the left atrial appendage (LAA). Thrombi that are large (≥15 mm) or exhibit mobility carry particularly high embolic risk, yet management can be challenging in patients with elevated bleeding risk. Advanced echocardiographic techniques now allow quantification of thrombus mobility, and dense spontaneous echo contrast (SEC) on transesophageal echocardiography has been identified as an independent predictor of thromboembolic events. We report the case of an 80-year-old woman with paroxysmal AF, non-Hodgkin lymphoma in remission, hypothyroidism, and a history of perforated gastric ulcer, in whom a large, mobile LAA thrombus (8 × 15 mm) was incidentally detected and confirmed by transesophageal echocardiography. Anticoagulation with warfarin, titrated to an INR of 2.5-3.0, led to complete thrombus resolution within six weeks. This case illustrates the substantial embolic risk associated with mobile LAA thrombi and demonstrates that individualized anticoagulation with careful monitoring can achieve safe and effective thrombus resolution in patients at high risk of bleeding. The novelty lies in highlighting individualized management as a viable strategy in this complex clinical setting, providing an important teaching point for practice.
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