Acute Coronary Syndrome of Embolic Origin in a Patient on Direct Thrombin Inhibitor Three Years After Mechanical Mitral Valve Replacement

Abstract

Dabigatran was shown to be inferior to warfarin for patients with mechanical heart valves.  However it was postulated that its inferiority was limited to early post-operative period where the valves had not been adequately endothelialized.  We present a case where thromboembolic acute coronary syndrome developed in a patient six months after switching from warfarin to dabigatran, despite three years after mechanical mitral valve replacement.  We propose an alternative explanation for dabigatran failure.