Mechanical prosthetic mitral valve thrombosis during dabigatran treatment

Dabigatran has been approved for prevention of thromboembolic complications in non-valvular atrial fibrillation. We present a case of a mechanical prosthetic mitral valve thrombosis during anticoagulation with dabigatran, switched in the last three months after 10 years treatment with warfarin. The patient presented with acute respiratory failure and decompensated heart failure. She was initially treated with unfractioned heparin and then was sent for emergency surgery for cardiogenic shock. As emerging from contemporary evidence and as recommended by guidelines, dabigatran, as well as the other direct oral anticoagulants, should be avoided in patients with mechanical valve prosthesis. Echocardiography is indicated if dyspnoea develops in such patients.