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The anticoagulation therapy was changed to the direct thrombin inhibitor bivalirudin with an improvement in the platelet count. Despite bivalirudin therapy, a left atrial layering thrombus was revealed on transoesophageal echocardiogram performed in preparation for cardioversion of the symptomatic atrial fibrillation. Anticoagulation was changed to warfarin, and the patient was discharged without thromboembolic complications neither during her hospital stay nor the 3-year outpatient follow-up.<\/jats:p>","DOI":"10.1136\/bcr-2018-225986","type":"journal-article","created":{"date-parts":[[2018,10,15]],"date-time":"2018-10-15T01:55:56Z","timestamp":1539568556000},"page":"bcr-2018-225986","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Bivalirudin fails to prevent atrial thrombus development in heparin-induced thrombocytopaenia and thrombosis syndrome"],"prefix":"10.1136","volume":"2018","author":[{"given":"Alexandru","family":"Topliceanu","sequence":"first","affiliation":[{"name":"Division of Cardiology, Albany Medical College, Albany Medical Center, Albany, New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2134-5158","authenticated-orcid":false,"given":"Thomas","family":"Breen","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Albany Medical College, Albany Medical Center, Albany, New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1589-791X","authenticated-orcid":false,"given":"Hiren","family":"Patel","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Albany Medical College, Albany Medical Center, Albany, New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Neil","family":"Yager","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Albany Medical College, Albany Medical Center, Albany, New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Erica","family":"Maceira","sequence":"additional","affiliation":[{"name":"Clinical Pharmacy Specialist, Albany Medical Center, Albany, New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mikhail","family":"Torosoff","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Albany Medical College, Albany Medical Center, Albany, New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2018,10,14]]},"reference":[{"doi-asserted-by":"publisher","key":"2025082805245960000_2018.oct13_1.bcr-2018-225986.1","DOI":"10.1378\/chest.11-2303"},{"doi-asserted-by":"publisher","key":"2025082805245960000_2018.oct13_1.bcr-2018-225986.2","DOI":"10.2146\/sp150018"},{"key":"2025082805245960000_2018.oct13_1.bcr-2018-225986.3","doi-asserted-by":"crossref","first-page":"809","DOI":"10.1056\/NEJMcp052967","article-title":"Heparin-induced thrombocytopenia","volume":"355","author":"Arepally","year":"2006","journal-title":"N Engl J Med Overseas Ed"},{"key":"2025082805245960000_2018.oct13_1.bcr-2018-225986.4","first-page":"967","volume-title":"Heparin-Induced Thrombocytopenia.\" Harrisons Principles of Internal Medicine, by D Longo","volume":"1","author":"Fauci","year":"2012"},{"unstructured":"Arnold DM , George JN . 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