Treatment failure of low molecular weight heparin bridging therapy in atrial fibrillation after acute coronary syndrome E. Imbalzano a, ⁎, R. Ceravolo b , R. Di Stefano c , M. Vatrano b , A. Saitta a a Department of Internal Medicine, University of Messina, Italy b Department of Cardiology, Hospital “Pugliese-Ciaccio” of Catanzaro, Italy c Department of Surgical Pathology, Medical, Molecular and Critical Area, University of Pisa, Italy article info Article history: Received 28 August 2013 Accepted 23 November 2013 Available online 4 December 2013 Keywords: Atrial fibrillation Thrombosis prevention Low-molecular-weight heparin Oral anticoagulant therapy Ischemic stroke Thrombosis prevention in atrial fibrillation [1–21] is a very common problem for cardiologists. Low molecular weight heparin bridging therapy (LMWH-BT) has been considered in patients at high risk of thromboem- bolism during the start or temporary interruption of oral anticoagulation therapy [22–24]. Several cases of treatment failure of LMWH-BT have been reported [25–27]. A 70-year-old man, with a history of arterial hypertension, recurrent atrial fibrillation and mild aortic valve stenosis in oral anticoagulant therapy [1–33], came to our observation for inferior STEMI (Fig. 1A) complicated by total BAV (Fig. 1B). In urgency was inserted PM temporary and revascularized with double DES for thrombotic occlusion of the proximal right coronary artery. The current therapy with LMWH was standardized according to body weight, beta-blockers, ACE inhibitors, diuretics, aspirin and clopidogrel [34–36]. After 3 days the ECG showed atrial fibrillation (Fig. 1C). After 6 days the patient has sudden expressive aphasia and hemi-facial-brachial left. Echocardiographic assessment did not detect the presence of thrombus in the cardiac chambers. A computed tomography [37,38] performed in emergency and after 24 h showed cerebral ischemic injury (Fig. 2). 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Martino” Via Consolare Valeria n.1, 98125 Messina, Italy. Tel.: +39 3392894665. E-mail address: e.imbalzano@libero.it (E. Imbalzano). 289 Letters to the Editor