Embolic Attack in Patients With Atrial Fibrillation and Atrial Thrombus Depends on the Character of the Thrombus.

Abstract

It is very important to prevent embolisms from left atrial thrombi (LAT). The present study was a trial for the management of patients with AT using 122 patients with atrial fibrillation and LAT who were followed for 1 year after transesophageal echocardiography. LAT were classified by their shape and mobility into the mobile ball type (MB, n=28), fixed ball type (FB, n=32) and mountain type (MO, n=42). The patients were given warfarin (INR: 1.5-2.0, n=43), aspirin 81 mg (n=74) and/or ticlopidine 200 mg/day (n=31). The embolic rate (ER) in the MB group was significantly higher than in the other groups [ie, MB 39.3% vs FB 15.6% (p<0.05), vs MO 2.4% (p<0.05)]. The ER in the FB group was significantly higher than in the MO group (p<0.05). Therapy with a combination of ticlopidine and aspirin reduced the ER in the patients with ball thrombi. The ER of the ball thrombus type group, especially the MB group, was very high in spite of therapy with anti-coagulants and/or anti-platelet agents, and such patients should be treated by early surgical intervention. However, the combination of ticlopidine and aspirin may be useful for preventing embolism.

Migration of Large Thrombus From the Left Atrial Appendage During Transesophageal Echocardiography in a Stroke Patient

“…4 LAA thrombus is an important source of embolic stroke. Understanding of its complex and extremely variable structure and careful observation of the echocardiographic appearance of the thrombus formation, may provide valuable supplementary information for the evaluation and management of thromboembolic events.…”

A Case of Embolism due to a Floating Thrombus Migrating from the Left Atrial Appendage to the Ostium of the Celiac Artery

“…1) The structure of the LAA is a rod-shaped pouch that may have stagnant blood flow, leading to hemostasis. 1) Abe et al 4,5) reported that LAA thrombi could be classified into three types: the mobile ball type, fixed ball type, and mountain ball type. The mobile ball type is associated with an especially high risk of embolism.…”

Higher Levels of Serum Fibrin-Monomer Reflect Hypercoagulable State and Thrombus Formation in the Left Atrial Appendage in Patients With Acute Ischemic Stroke

“…However, it is sometimes difficult to make a diagnosis because of the splashing and vanishing of the intracardiac source of the emboli. [4][5][6][7][8][9][10][11][12] In patients with cardioembolic stroke it is necessary to carefully examine the intracardiac hypercoagulable state based on echocardiographic findings and/or serum sensitive markers, and then use this information to prevent recurrent attacks.It is well known that the left atrial appendage (LAA) is a major thromboembolic source in cardioembolic stroke. 7,8 Many clinical reports have shown a close relationship between LAA thrombus formation and left atrial mechanical remodeling, based on echocardiographic findings such as the presence of spontaneous echo contrast or a progressive Circulation Journal Vol.70, August 2006 reduction in LAA emptying flow velocity.…”

“…7,8 Many clinical reports have shown a close relationship between LAA thrombus formation and left atrial mechanical remodeling, based on echocardiographic findings such as the presence of spontaneous echo contrast or a progressive Circulation Journal Vol.70, August 2006 reduction in LAA emptying flow velocity. 6,10,12,13 Serum fibrin monomer (FM) is a precursor of the fibrin polymer that is produced by the thrombin-mediated resolution of fibrinopeptide A from fibrinogen. In vivo, compared with fibrin polymer and stable fibrin, FM is fragile as a result of fibrinolysis.…”

“…However, it is sometimes difficult to make a diagnosis because of the splashing and vanishing of the intracardiac source of the emboli. [4][5][6][7][8][9][10][11][12] In patients with cardioembolic stroke it is necessary to carefully examine the intracardiac hypercoagulable state based on echocardiographic findings and/or serum sensitive markers, and then use this information to prevent recurrent attacks.…”