Treatment of atrial fibrillation in complex patients: a case report beyond the obvious

Il trattamento della fibrillazione atriale nei pazienti complessi: un caso clinico oltre l’ovvio

Abstract

Many cardiovascular diseases and comorbidities increase the risk of atrial fibrillation (AF) and further complications. Identifying and managing these conditions is critical for the prevention and control of AF, contributing to optimal patient management. We describe the case of a 74-year-old patient suffering from arterial hypertension and diabetes mellitus, with HCV related liver disease evolved into liver cirrhosis. The patient received aorto-coronary bypass for ischemic heart disease and PTCA for unstable angina. After six months paroxysmal episodes of AF developed and therapy with sotalol and edoxaban was started. Following an increase in the severity of paroxysmal AF, with the occurrence of an episode requiring cardiovertion, we opted to control the frequency with a pharmacological strategy. Due to the marked deterioration of liver function, severe anemia, thrombocytopenia and Grade I esophageal varices, edoxaban was discontinued and therapy with fondaparinux was initiated. After treatment with corticosteroids and antibiotics, the patient was discharged and reintroduction of NOAC therpy was evaluated. After consulting with a liver disease specialist, it was decided to start therapy with dabigatran. Since then the patient is asymptomatic and in stable clinical conditions. The management of AF in complex patients requires an integrated approach that takes into account individual diseases as well as the overall risk profile. In this context, NOACs in general and dabigatran in particular represent a therapeutic option that allows to ensure adequate prevention of thromboembolic risk and to limit the risk of bleeding (Cardiology)