The following information was obtained from a literature article titled " a case of thrombosis occurred in a patient taking novel oral anticoagulants (noac)" from the japanese journal of artificial organs, vol.44 no.2.2015.A late 50s male underwent mitral valve replacement and maze operation 15 years ago for the treatment of mitral stenosis and spasmodic atrial fibrillation.This 27 mm sjm mechanical valve was implanted as well as a pacemaker (ddd).The patient was taking warfarin but recently (unknown date), he switched from warfarin to dabigatran.Three months ago, the patient presented with congestive heart failure and was hospitalized twice in local hospital and diuretics were administered.Five days later, the patient's respiratory status deteriorated and non-invasive positive-pressure ventilation (nppv) was started.An echocardiogram confirmed mitral stenosis and the patient was referred to the hospital by ambulance with intubation.The patient had shock symptoms and cerebral hypoxia (fio2 100%, po2 89mmhg).This 27 mm sjm mechanical valve had leaflet immobility and the left ventricular chamber had shrunk.Moderate tricuspid regurgitation was also observed.An emergency re-do mitral valve replacement was performed due to severe thrombosis.This 27 mm sjm mechanical valve was explanted and replaced with a 27 mm ats mechanical valve.Tap (kay-reed) was also performed.After the surgery, brain ct confirmed cerebral hypoxia.The patient underwent percutaneous endoscopic gastrostomy (peg) and he was transferred to another hospital in a vegetative state.
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