Incidence and Predictors of Left Atrial Appendage Thrombus in Patients Treated With Nonvitamin K Oral Anticoagulants Versus Warfarin Before Catheter Ablation for Atrial Fibrillation

Wyrembak, Joanne; Campbell, Kevin R; Steinberg, Benjamin A.; Bahnson, Tristram D.; Daubert, James P.; Velázquez, Eric J.; Samad, Zainab; Atwater, Brett D.

doi:10.1016/j.amjcard.2016.12.008

Cited by 41 publications

(52 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…None of the patients in this study taking a NOAC had LA/LAA thrombus; their demographics were comparable to the rest of the population, and the CHA 2 DS 2 VASc scores ranged from 0 to 5, similar to the population on warfarin. This finding is consistent with other studies that have shown that the incidence of thrombus in patients undergoing pre-ablation TOE is either similar (21) or less (22) than those patients on warfarin.…”

Section: Discussionsupporting

confidence: 92%

Use of the CHA ₂ DS ₂ VASc score to reduce utilisation of transoesophageal echocardiography prior to ablation for atrial fibrillation

et al. 2017

View full text Add to dashboard Cite

Transoesophageal echocardiography (TOE) is frequently performed prior to atrial fibrillation (AF) ablation to exclude left atrial appendage (LAA) thrombus. However, patients undergoing AF ablation are usually anticoagulated, thus making the presence of thrombus unlikely in most cases. This study aimed to determine whether the CHA2DS2VASc scoring system can be used to identify patients that do not require TOE prior to AF ablation. In this single-centre retrospective study, local institutional and primary care databases and electronic patient records were searched to identify patients that had undergone TOE prior to AF ablation. Patient demographics, CHA2DS2VASc score, TOE findings and anticoagulation status were collected for analysis. Over a 7-year period (2008–2014), 332 patients (age 57 ± 10 years; 74% male) underwent TOE prior to proposed AF ablation. CHA2DS2VASc scores of 0, 1, 2 and >2 were found in 39, 34, 15 and 12% of patients, respectively. The prevalence of LAA thrombus was 0.6% (2 patients) and these 2 patients had risk scores of 2 and 4. No patients with a score of 0 or 1 had LAA thrombus. Patients that are classed as low risk by the CHA2DS2VASc score do not require a pre-ablation TOE to screen for LAA thrombus provided they are adequately anticoagulated. This would lead to a significant reduction in health care expenditures by reducing unnecessary TOE requests and thereby improve patient experience.

show abstract

Section: Discussionsupporting

confidence: 92%

Use of the CHA ₂ DS ₂ VASc score to reduce utilisation of transoesophageal echocardiography prior to ablation for atrial fibrillation

et al. 2017

View full text Add to dashboard Cite

show abstract

“…In our study, we found no difference in the LAAT incidences among the four NOACs apixaban, dabigatran, edoxaban, and rivaroxaban and no difference compared to continuous VKA therapy. Wyrembak et al., on the other hand, found significantly lower LAAT incidences in patients treated with NOACs (dabigatran, apixaban, and rivaroxaban) compared to patients on warfarin. Further trials are needed to follow‐up on these observations.…”

Section: Methodsmentioning

confidence: 99%

Risk stratification of patients with left atrial appendage thrombus prior to catheter ablation of atrial fibrillation: An approach towards an individualized use of transesophageal echocardiography

Gunawardene

Dickow

Schaeffer

et al. 2017

Cardiovasc electrophysiol

View full text Add to dashboard Cite

show abstract

“…Similar to the analysis of Gunawardene et al ., high CHADS 2 and CHA 2 DS 2 ‐VASc scores were found to be independent predictors of LAAT in multivariate analysis of previous studies as well . Puwanant et al.…”

mentioning

confidence: 71%

“…Wyrembak et al . published a single‐center retrospective study that compared the prevalence of LAAT in 517 warfarin‐treated patients versus 420 patients on NOACs prior to AF ablation.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Evaluation of left atrial thrombus prior to catheter ablation of atrial fibrillation: Is it time for an individualized approach?

Laish-Farkash

Suleiman

2017

Cardiovasc electrophysiol

View full text Add to dashboard Cite

Incidence and Predictors of Left Atrial Appendage Thrombus in Patients Treated With Nonvitamin K Oral Anticoagulants Versus Warfarin Before Catheter Ablation for Atrial Fibrillation

Cited by 41 publications

References 17 publications

Use of the CHA ₂ DS ₂ VASc score to reduce utilisation of transoesophageal echocardiography prior to ablation for atrial fibrillation

Use of the CHA ₂ DS ₂ VASc score to reduce utilisation of transoesophageal echocardiography prior to ablation for atrial fibrillation

Risk stratification of patients with left atrial appendage thrombus prior to catheter ablation of atrial fibrillation: An approach towards an individualized use of transesophageal echocardiography

Evaluation of left atrial thrombus prior to catheter ablation of atrial fibrillation: Is it time for an individualized approach?

Contact Info

Product

Resources

About

Incidence and Predictors of Left Atrial Appendage Thrombus in Patients Treated With Nonvitamin K Oral Anticoagulants Versus Warfarin Before Catheter Ablation for Atrial Fibrillation

Cited by 41 publications

References 17 publications

Use of the CHA 2 DS 2 VASc score to reduce utilisation of transoesophageal echocardiography prior to ablation for atrial fibrillation

Use of the CHA 2 DS 2 VASc score to reduce utilisation of transoesophageal echocardiography prior to ablation for atrial fibrillation

Risk stratification of patients with left atrial appendage thrombus prior to catheter ablation of atrial fibrillation: An approach towards an individualized use of transesophageal echocardiography

Evaluation of left atrial thrombus prior to catheter ablation of atrial fibrillation: Is it time for an individualized approach?

Contact Info

Product

Resources

About

Use of the CHA ₂ DS ₂ VASc score to reduce utilisation of transoesophageal echocardiography prior to ablation for atrial fibrillation

Use of the CHA ₂ DS ₂ VASc score to reduce utilisation of transoesophageal echocardiography prior to ablation for atrial fibrillation