Incidence of left atrial abnormalities under treatment with dabigatran, rivaroxaban, and vitamin K antagonists

Abstract

BackgroundNon-vitamin K antagonist oral anticoagulants (NOACs) such as dabigatran or rivaroxaban are alternatives to vitamin K antagonists (VKAs) for prevention of stroke and systemic embolism in patients with atrial fibrillation (AF) and atrial flutter (AFL). Incidences of risk factors for left atrium (LA) and left atrial appendage (LAA) thrombus formation, such as dense spontaneous echo contrast (SEC), low LAA velocity (LAAV) <20 cm/s under treatment with dabigatran and rivaroxaban in comparison with VKAs are unknown.MethodsWe studied 306 patients with AF (94 %) and AFL (6 %) undergoing transesophageal echocardiography. Patients received VKAs (n = 138), dabigatran (n = 68), or rivaroxaban (n = 100) for at least 3 weeks prior to investigation. Time in therapeutic range was 67 % for VKA. Mean CHADS2 score and CHA2DS2-VASc score were 1.3 and 2.5, respectively. Left atrial abnormality was defined as either dense SEC, low LAAV <20 cm/s, or thrombus.ResultsAny LA abnormality occurred in 9, 3, and 5 % of patients receiving VKA, dabigatran, and rivaroxaban, respectively. The most frequent abnormality was LAA thrombus (VKA: 4 %, dabigatran: 0 %, rivaroxaban: 2 %) and low LAAV of less than 20 cm/s (VKA: 4 %, dabigatran: 1 %, rivaroxaban: 1 %), followed by dense SEC (VKA: 2 %, dabigatran: 1 %, rivaroxaban: 2 %). Results of uni- and multivariate analyses revealed a numerically lower but not significantly different frequency of any LA abnormality under dabigatran (OR 0.4, 95 % Cl 0.08 − 1.88, p = 0.25) and rivaroxaban (OR 0.65, 95 % Cl 0.22 − 1.98, p = 0.45) compared to VKA.ConclusionWith respect to the incidence of LA abnormalities, dabigatran and rivaroxaban are not inferior to VKA.

Comparison of different oral anticoagulant regimens in patients with atrial fibrillation undergoing ablation or cardioversion

“…9 The same applies to the com parison of our results to the study by Mitamura et al, 37 who reported the frequency of LA throm bus at 0.5% in patients treated with dabigatran at a dose of 150 mg twice daily and 3.5% in those treated with dabigatran at a dose of 110 mg twice daily. In the study by Reers et al, 38 LA thrombus was observed in 4% of patients treated with VKAs, 0% in patients treated with dabigatran, and 2% in patients treated with rivaroxaban. However, a study by Zylla et al 39 revealed a significantly higher prevalence of intracardiac thrombi in pa tients on VKA therapy (17.8%) than those on dab igatran (3.8%) or rivaroxaban (4.1%).…”

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

“…TEE-related complications occurred in 0.3%. 21 Reers et al 22 showed a numerically lower but not significantly different…”

“…TEE-related complications occurred in 0.3%. 21 Reers et al 22 showed a numerically lower but not significantly different frequency of any left atrium (LA) abnormality (LAAT, dense spontaneous echo contrast or low LAA velocity) under dabigatran and rivaroxaban compared with VKA. Frenkel et al 23 In contrast, Di Biase et al 24 showed in a recent prospective multicenter registry of AF patients undergoing AF ablation on uninterrupted NOACs that periprocedural stroke rate was extremely low Similar to the analysis of Gunawardene et al, 20 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.…”

“…TEE‐related complications occurred in 0.3% . Reers et al . showed a numerically lower but not significantly different frequency of any left atrium (LA) abnormality (LAAT, dense spontaneous echo contrast or low LAA velocity) under dabigatran and rivaroxaban compared with VKA.…”

Frequency of atrial thrombus formation in patients with atrial fibrillation under treatment with non-vitamin K oral anticoagulants in comparison to vitamin K antagonists: a systematic review and meta-analysis

“…The EMANATE trial, a randomised, active-controlled, open-labelled study showed a prevalence of thrombus formation in anticoagulation-naive AF patients of 7.1% [ 26 ]. The frequencies of thrombus formation under treatment with VKA vary between 3.5% and 17.8% [ 16 , 17 , 20 , 21 , 27 ]. Controlled therapeutic anticoagulation with VKA (INR 2.0–3.0) exhibited the lowest rates of intracardiac thrombus formation among retrospective studies to be of 0.6–7.7% [ 15 , 19 , 28 ].…”