Patient with non-valvular atrial fibrillation on ineffective anticoagulant therapy

Atrial fibrillation is a major risk factor of stroke. Anticoagulant therapy is widely used in order to avoid thromboembolic episodes. We introduce a patient with sustained atrial fibrillation and many cardiologic conditions, who had CRT-D implanted one month earlier. Anticoagulant therapy has been paused in periprocedural period. Patient had stroke in the first week of anticoagulation therapy, then high fever appeared during hospitalisation in the Neurology Clinic, which was considered as connected to peripheral venous catheter. Lack of positive result of the antibiotic therapy determined the probability of infective endocarditis. Patient was admitted to the Cardiology Clinic. Performed imaging - transoesophageal echocardiography showed no valvular vegetation, but thrombus in left atrial appendage was observed. CRT-D device was explanted and unfractionated heparin was used in periprocedural period. Ineffective anticoagulant therapy may also lead to the higher risk of thromboembolism. Infective endocarditis is an additional risk factor of both: thromboembolism and bleeding.