Left atrial thrombus and prognosis after anticoagulation therapy in patients with atrial fibrillation

Fukuda, Shota; Watanabe, Hiroyuki; Shimada, Kenei; Aikawa, Masanori; Kono, Yasushi; Jissho, Satoshi; Taguchi, Haruyuki; Umemura, Jun; Yoshiyama, Minoru; Shiota, Takahiro; Sumiyoshi, Tetsuya; Yoshikawa, Junichi

doi:10.1016/j.jjcc.2011.06.009

Cited by 44 publications

(48 citation statements)

References 34 publications

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“…5 The PT-INR value in our study was also relatively low (1.9 ± 0.6), which may have contributed to the higher frequency of LAAT. 24 PT-INR and TTR are generally considered the better markers for adequate warfarinization, as patients with PT-INR of 2.0-3.0 or TTR >60-65% were reported to be at lower risk of stroke. 18 19 However, in the present study, there are no significant differences in PT-INR and TTR between the M A N U S C R I P T…”

Section: Discussionmentioning

confidence: 99%

Prevalence and Clinical Determinants of Left Atrial Appendage Thrombus in Patients With Atrial Fibrillation Before Pulmonary Vein Isolation

Nishikii-Tachibana

Murakoshi

Seo

et al. 2015

The American Journal of Cardiology

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Section: Discussionmentioning

confidence: 99%

Prevalence and Clinical Determinants of Left Atrial Appendage Thrombus in Patients With Atrial Fibrillation Before Pulmonary Vein Isolation

Nishikii-Tachibana

Murakoshi

Seo

et al. 2015

The American Journal of Cardiology

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“…Nevertheless, this study was conducted in non valvular atrial fibrillation population which did not reflect our patient situation closely. 8 Jaber et al 9 found thrombus resolution in 80.1% of patients who received anticoagulation for 47±18 days. Contrast to plenty of data available on the usage of warfarin, the data of lumbrokinase for left atrial thrombus are limited.…”

Section: Discussionmentioning

confidence: 97%

“…20 Cheol et al 21 found six of nine patients with adequate anticoagulation with warfarin had persistent trombi eventhough the size of thrombi decreased from 2.2±0.8 cm to 0.9±1.0 cm. 21 A study conducted by Fukuda et al 8 revealed a better result, left atrial thrombus was found in 8.8% of patients with sub-therapeutic anticoagulation therapy and in 3.6% of patients with sufficient anticoagulation therapy. Nevertheless, this study was conducted in non valvular atrial fibrillation population which did not reflect our patient situation closely.…”

Section: Discussionmentioning

confidence: 98%

“…[3][4][5][6] The best antithrombotic strategy is not known and several studies showed that in some patients despite receiving anticoagulation, the thrombus may persist. [7][8][9][10] This opens possibility to introduce a new therapeutic agent for significant dissolution without adding an increased risk of adverse effects especially bleeding.…”

Section: Introductionmentioning

confidence: 99%

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Dissolution of large intracardiac thrombus, potential role of the emerging oral fibrinolytic agent

Candrasatria

Kasim

2016

Med J Indones

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Intracardiac thrombus may persist in some cases even after anticoagulant therapy. This opens a possibility to add a potent thrombolytic agent into therapeutic regimen without increasing bleeding risk any further. Increasing evidence showed a promising efficacy and safety of oral fibrin specific lumbrokinase as a thrombolytic agent. To the best of our knowledge, report of the use of lumbrokinase on intracardiac thrombus is limited. We reported two cases of intracardiac thrombi. In first patient, after two-month therapy with lumbrokinase, the previous 8 cm 2 left atrial thrombus was completely disappeared. Second patient had left ventricular thrombus due to low left ventricular ejection fraction caused by coronary artery disease. A significant dissolution in thrombus size on repeated follow-up was found. Both patients did not experience any significant adverse effect. This case series aims to present the potential use of lumbrokinase as as oral antithrombotic therapy in intracardiac thrombus.

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“…In two other studies with small patient numbers, resolution rates of [80 % were reported after 4 weeks of treatment with warfarin with a target INR C21 [7,18]. However, due to differences in patient populations, anticoagulant treatment duration, effective INR levels, and thrombus visualization by TEE, it is difficult to compare these studies [18][19][20][21].…”

Section: Introductionmentioning

confidence: 99%

Rationale and design of the RE-LATED AF—AFNET 7 trial: REsolution of Left atrial-Appendage Thrombus—Effects of Dabigatran in patients with Atrial Fibrillation

et al. 2015

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Background Dabigatran etexilate, a direct thrombin inhibitor and non-vitamin K antagonist oral anticoagulant (NOAC), has been shown to effectively prevent thromboembolic events in patients with non-valvular atrial fibrillation (AF). However, there is a paucity of data on the antithrombotic efficacy and safety of dabigatran in the resolution of left atrial appendage (LAA) thrombi in AF patients.Objective The primary objective of the RE-LATED AF trial is to assess whether dabigatran results in a faster complete LAA thrombus resolution as compared to vitamin K antagonist phenprocoumon. Secondary objectives are to assess the impact of dabigatran on complete LAA thrombus resolution rate within 6 weeks of treatment and change in LAA thrombus volume under treatment. Furthermore, this study aims to assess and compare safety and tolerability of dabigatran vs. phenprocoumon. MethodsThe study is designed as a prospective, randomized, open-label, controlled, explorative, blinded endpoint (PROBE) trial. Patients with AF and left atrial appendage thrombus confirmed by transoesophageal echocardiography (TEE) will be randomized to receive either dabigatran (150 mg bid) or phenprocoumon (INR 2-3) for the resolution of LAA thrombus formation for at least 21 days. Thrombus resolution will be determined by TEE 3 weeks after treatment initiation and subsequently at weeks 4 and 6, if the LAA thrombus has not been resolved before. A total of 110 patients are planned to be randomized. Conclusion This is the first prospective, multicentre, randomized controlled clinical trial investigating safety and efficacy of a NOAC for the resolution of LAA thrombi in patients with non-valvular AF.

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Left atrial thrombus and prognosis after anticoagulation therapy in patients with atrial fibrillation

Abstract: We demonstrated that LAT was a univariate risk factor associated with worse cardiovascular outcomes, which was observed in 8.8% of patients with sub-therapeutic anticoagulation and 3.6% of patients with sufficient anticoagulation.

Cited by 44 publications

References 34 publications

Prevalence and Clinical Determinants of Left Atrial Appendage Thrombus in Patients With Atrial Fibrillation Before Pulmonary Vein Isolation

Prevalence and Clinical Determinants of Left Atrial Appendage Thrombus in Patients With Atrial Fibrillation Before Pulmonary Vein Isolation

Dissolution of large intracardiac thrombus, potential role of the emerging oral fibrinolytic agent

Rationale and design of the RE-LATED AF—AFNET 7 trial: REsolution of Left atrial-Appendage Thrombus—Effects of Dabigatran in patients with Atrial Fibrillation

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