PMC7772403_01
Time course of argatroban treatment, radiology, coagulation/fibrinolysis tests, and echocardiography findings. APTT, activated partial thromboplastin time; DD, D-dimer; INR, international normalized ratio; HT, hemorrhagic transformation; x, discontinuation of argatroban.
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F1
INR was at 1.61. In the meantime, the activated partial thromboplastin time (APTT, normal range: 25-31.3 s), thrombin time (TT, normal range: 13-21 s), and her thromboelastography (TEG) indicated no abnormality (Figure 1). Cerebral CT scan (Figures 2A,B) showed: 1) multiple acute infarcts in the right frontal, temporal parietal lobe, 2) temporal lobe hematoma, 3) right internal capsule infarct, 4) right cerebellar infarct, and 5) brain stem infarct. After one dose of argatroban, the level of fibrinogen was normalized to 1.5 g/L and D-dimer to 7.83 mg/L (Figure 1), which suggested the efficacy of anticoagulation resumption. Unfortunately, the day after argatroban discontinuation, the echocardiograph demonstrated an aortic valve thrombosis leading to valvular insufficiency and a surge in aortic flow rate to 4.75 m/s (Figure 1).
Head computed tomography scan on admission (A, B) and before discharge (C, D).
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F2
Cerebral CT scan (Figures 2A,B) showed: 1) multiple acute infarcts in the right frontal, temporal parietal lobe, 2) temporal lobe hematoma, 3) right internal capsule infarct, 4) right cerebellar infarct, and 5) brain stem infarct. The CT scan before her discharge (Figures 2C,D) showed a reduction of hematoma volume; the CT perfusion demonstrated that the regional cerebral blood volume (CBV) and cerebral blood flow (CBF) were reduced in the right temporoparietal lobe while mean transit time (MTT) and time to peak (TPP) prolonged.