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Background: Nonvalvular atrial fibrillation (AF) is the most common cause of systemic embolism. In rare cases, AF can cause coronary artery embolism which is a rare but important nonatherosclerotic cause of acute myocardial infarction.1 Case report: We report the case of 81-years-old man with permanent atrial fibrillation who presented to our hospital with ST segment elevation myocardial infarction. Coronary angiography verified the embolic occlusion of distal posterolateral branch, which is a branch of the right coronary artery, unsuitable for percutaneous coronary intervention, and no significant atherosclerotic coronary artery disease was found. Transthoracic echocardiography showed a slightly reduced left heart systolic function (EF 45-50%), higher grade diastolic dysfunction and reduced longitudinal strain in inferoposterior segments of left ventricle (-2 to -7). The patient was treated according to the current guidelines. Conclusion: Proper anticoagulant therapy in patients with atrial fibrillation is extremely important in order to prevent thrombus formation, and consequently, the embolism commonly occurring in these conditions. Echocardiographic measurement of the longitudinal strain could indicate a greater possibility of forming the thrombus in patients with impaired cardiac contractility. At present, measurement of the ventricular strain is recommended as a better method for estimating the systolic function from the measurement of the ejection fraction. Using this method, it is better to examine segmental mobility of individual parts of the ventricle and to better evaluate contractility. Also, the strain may point to the hipo(a)contractility of the ventricle. In this case, there is a possibility that in this negligible part of the ventricle, conditions for the thrombus formation were created. Is this the case in this patient we cannot safely claim. Research is needed to confirm this assumption. [ABSTRACT FROM AUTHOR]

Background. Drug-drug interactions (DDIs) are one potential cause of adverse drug events. Very little has been done to study the relationship between potential DDIs in patients (p) with atrial fibrillation (AF) on direct oral anticoagulants (DOACs). Many anticoagulants are eliminated by the kidneys, so they can accumulate if their dose is not adapted to the kidney function. DDI is one particular type of drug error that can result in adverse drug events (ADEs) in exposed patients and was the aim of this study. Materials and Methods. A total of 50 patients with AF on DOACs (25 patients on dabigatran and 25 on rivaroxaban) with normal, mildly or moderately decreased (estimated GFR > 30 mlmin-11.73m2) renal function were included (age 69±7 years, 26M/24F, body mass index (BMI) 35.4±5.1 kg/m2, duration of hypertension 11±5 years, duration of AF 5±2 years, eGFR 58±23 mlmin-11.73m2 (was calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula). Results. The 12-month administration of DOACs caused a nonsignificant decrease of eGFR (declined from 58±23 mlmin-11.73m2 to 56±17 mlmin-11.73m2 (p=0.01). All patients have the right dose of DOACs according to eGFR. Patients with AF and DOACs on more than 3 different drugs (20%) such as statins, verapamil and amiodarone were more prone to AE. Conclusion. DDIs are one of the most important problems in every day practice. Coadministration of statins with dabigatran worsens clinical outcomes and a similar interaction might be seen with verapamil and amiodarone. Patients need to be on the right drug/right dose given the kidney function they have, with special care on DDIs. [ABSTRACT FROM AUTHOR]