Antithrombotic Strategies and Complication Management in Paroxysmal Atrial Fibrillation Complicated by Mesenteric Artery Embolism: A Case Report and Literature Review of an Elderly Patient

Guojian Lin; Shijin Chen; Xinxin Liu; Qian Yang

doi:10.26689/cr.v3i3.12161

Guojian Lin The Second People’s Hospital of Yichang City, Affiliated to China Three Gorges University, Yichang 443000, Hubei, China
Shijin Chen Department of Emergency Medicine, Karamay Central Hospital, Karamay 834000, Xinjiang Uygur Autonomous Region, China
Xinxin Liu Department of Emergency Medicine, Karamay Central Hospital, Karamay 834000, Xinjiang Uygur Autonomous Region, China
Qian Yang Department of Emergency Medicine, Karamay Central Hospital, Karamay 834000, Xinjiang Uygur Autonomous Region, China

DOI: https://doi.org/10.26689/cr.v3i3.12161

Keywords: Paroxysmal atrial fibrillation, Mesenteric artery embolism, Anticoagulant therapy, Reperfusion injury, Bleeding risk management

Abstract

Objective: To explore antithrombotic strategy selection and bleeding complication management in patients with paroxysmal atrial fibrillation (AF) complicated by acute mesenteric artery embolism (AME). Methods: The diagnosis and treatment process of an 84-year-old patient with AF complicated by AME was reviewed, and the balancing strategy between antithrombotic therapy and reperfusion injury was analyzed in conjunction with the literature. Results: The patient developed intestinal bleeding and abdominal wall hematoma after interventional thrombectomy, and the risks of thrombosis and bleeding were ultimately controlled through a dual antithrombotic regimen of rivaroxaban combined with clopidogrel. Conclusion: For AF complicated by AME, individualized weighing of thromboembolic and bleeding risks is necessary, and multidisciplinary collaboration and dynamic monitoring are crucial for optimizing treatment.

References

Hindricks G, Potpara T, Dagres N, et al., 2021, 2020 ESC Guidelines for the Diagnosis and Management of Atrial Fibrillation Developed in Collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the Diagnosis and Management of Atrial Fibrillation of the European Society of Cardiology (ESC) Developed with the Special Contribution of the European Heart Rhythm Association (EHRA) of the ESC. European Heart Journal, 42(5): 373–498.

Lip G, Banerjee A, Boriani G, et al., 2021, Antithrombotic Therapy for Atrial Fibrillation: Association for the Advancement of Medical Instrumentation. Journal of the American College of Cardiology, 77(5): 629–658.

Becattini C, Agnelli G, Jimenez D, et al., 2022, Anticoagulation in Acute Mesenteric Ischemia. Thrombosis Research, 214: 53–61.

Acosta S, Björck M, Wahlgren C, et al., 2022, Delayed Anticoagulation in Acute Mesenteric Thrombosis. Annals of Vascular Surgery, 85: e45–e52.

Patel R, Ruff C, Goldhaber S, et al., 2023, Non-Vitamin K Antagonist Oral Anticoagulant Dosing in Renal Dysfunction. Circulation, 147(8): e93–e112.

Yang S, Fan X, Wang R, et al., 2021, Management of Reperfusion Injury in Mesenteric Ischemia. World Journal of Emergency Surgery, 16(1): 45.

Chinese Society of Cardiology, Chinese Medical Association, 2022, Expert Consensus on Risk Management of Atrial Fibrillation Complicated by Bleeding. Chinese Journal of Cardiology, 50(6): 521–530.

Tomaselli G, Mahaffey K, Cuker A, et al., 2022, 2021 ACC Expert Consensus Decision Pathway on the Management of Bleeding in Patients on Oral Anticoagulants: A Report of the American College of Cardiology Solution Set Oversight Committee. Journal of the American College of Cardiology, 79(11): 1119–1153.

Chinese Society of Interventional Radiology, Chinese Medical Doctor Association, 2023, Expert Consensus on Multidisciplinary Diagnosis and Treatment of Mesenteric Artery Embolism. Chinese Journal of Interventional Imaging and Therapy, 20(2): 1–6.

Chinese Society of Surgery, Chinese Medical Association, 2021, Guidelines for the Diagnosis and Treatment of Acute Mesenteric Ischemia. Chinese Journal of Practical Surgery, 41(4): 361–368.