BACKGROUND Evidence-based recommendations about anticoagulation in acute type B aortic dissection (TBAD) are completely missing, but there is a diffuse conviction that it could prevent the healing process of the dissected aorta's false lumen. However, several clinical conditions may lead to the necessity to start anticoagulant therapy among patients with acute type B aortic dissection, ranging from atrial fibrillation to more complicated clinical scenarios and the correct management in this kind of patients is still an open issue. CASE PRESENTATION We are presenting a 51-years-old man with multi-infarct encephalopathy referred to us for an acute TBAD and a first diagnosis of ischemic cardiomyopathy complicated by left ventricular (LV) thrombus formation. Coronary angiography revealed a critical stenosis of left anterior descending artery (LAD) treated with drug-eluting stent deployment. The patient was addressed to triple antithrombotic therapy with acetylsalicylic acid, clopidogrel and warfarin with target INR 2.0-2.5. After 6 months, computed tomography angiography revealed the stability of the dissection flap. Cardiac magnetic resonance imaging, however, confirmed the persistence of a small thrombotic formation in LV apex, thus double antithrombotic therapy with warfarin and clopidogrel was instituted. The patient remained asymptomatic during the follow-up period but was advised to suspend his job and physical activities. CONCLUSION Current guidelines do not discuss anticoagulant therapy in the setting of TBAD and large randomized trials are lacking. Despite it is generally considered unsafe to administer anticoagulants in patients with TBAD, we present a case in which triple antithrombotic therapy was well tolerated and did not lead to progression of the intimal flap after 6 months.

中文翻译：

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急性B型主动脉夹层的抗凝和抗血栓治疗：当现实生活中面临循证医学的阴影时。

背景技术关于急性B型主动脉夹层（TBAD）抗凝的循证医学建议已被完全遗失，但有一种弥漫性的信念，即它可能阻止解剖的主动脉假管腔的愈合。然而，从房颤到更复杂的临床情况，急性B型主动脉夹层患者可能需要开始一些抗凝治疗，而对这类患者的正确治疗仍是一个悬而未决的问题。病例介绍我们介绍了一名51岁的患有多发性梗塞性脑病的男子，该病因急性TBAD而被转诊给我们，并首次诊断为缺血性心肌病并发左室（LV）血栓形成。冠状动脉造影显示用药物洗脱支架展开治疗的左前降支（LAD）狭窄。该患者接受了乙酰水杨酸，氯吡格雷和华法林三联抗栓治疗，目标INR 2.0-2.5。6个月后，计算机断层血管造影显示了夹层皮瓣的稳定性。但是，心脏磁共振成像证实了LV尖尖仍存在少量血栓形成，因此，采用华法令和氯吡格雷进行了双重抗血栓治疗。该患者在随访期间无症状，但被建议中止其工作和体育锻炼。结论当前的指南没有讨论在TBAD情况下​​的抗凝治疗，并且缺乏大型随机试验。