Abstract P120: Heparin-warfarin Therapy Could Be An Alternative Treatment For Diabetes Mellitus In Addition To Being A Standard Therapy For Pulmonary Vein Thrombi.

Abstract

Background: Our previous study showed that warfarin or direct oral anticoagulants (DOACs) dissolved pulmonary vein thrombi (PVTs). However, in some instances, warfarin or DOACs could not dissolve PVT. It is unclear whether heparin-warfarin therapy affects PVT and diabetes mellitus (DM). Methods and Results: Our patient was a 74 year-old male. The patient had cerebral infarction one year prior; at that time, he was not treated with any medications. The patient was examined, and it was found that he had diabetes mellitus, hypertension and dyslipidemia. His HbA1c was 9.5%. The patient was treated with medications including ipraglifilozin L-proline (50 mg), sitagliptin (50 mg), repaglinide (0.25 mg) and clopidogrel (75 mg). One year after discharge, we detected PVTs in the patient’s left lower pulmonary vein (LLPV) via cardiac CT and transesophageal echocardiography (TEE). He was treated with standard doses of heparin and warfarin after stopping clopidogrel. The patient’s HbA1c was 6.2% at admission. After one month of treatment with heparin-warfarin, the PVTs were almost dissolved. The patient showed a tendency of hypoglycemia the day after admission, so the three glucose-lowering medications were discontinued within nine days. One month later, HbA1c was 6.1% without DM medications. After discharge, warfarin was continued, and blood glucose levels gradually increased. Three months later, HbA1c was 7.3%, and 4 months later, HbA1c was 7.8%, so DM medications were restarted. PVTs can release microclots, which can occlude the microvessels of all organs, leading to cell dysfunction. Heparin-warfarin can decrease microclots and reopen microvessels. Thus, blood glucose could be taken into cells, decreasing blood glucose levels. There is a possibility that DM could be prevented if we treat PVTs in their early stage. Compared to other similar cases, this patient showed hypoglycemia rather early, which might be caused by the interaction between repaglinide and clopidogrel. Conclusion: One month of heparin-warfarin therapy almost completely dissolved PVTs. During that course, DM medications were stopped in order to prevent hypoglycemia. During the next four months of warfarin therapy, the blood glucose levels gradually increased without DM medications.