Left atrial thrombus and smoke resolution in patients with atrial fibrillation under chronic oral anticoagulation

Cori, A Di; Barletta, Valentina; Meola, Laura; Parollo, M; Mazzocchetti, L; Carluccio, Marisa; Branchitta, G; Cellamaro, T; Gentile, Francesco; Segreti, Luca; Viani, Stefano; Lucia, R De; Soldati, Ezio; Zucchelli, Giulio; Bongiorni, Maria Grazia

doi:10.1007/s10840-022-01169-1

Cited by 5 publications

(4 citation statements)

References 28 publications

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“…However, in patients with nutritional problems, food interaction may influence the efficacy of OACs (especially warfarin) for thromboembolic prevention (21). A recent investigation demonstrated that OAC changing was associated with LA/LAA thrombus resolution in more than 50% of cases, especially after a switch to a new fulldose NOAC (22). Therefore, direct oral anticoagulants may be preferred to warfarin due to fewer food interactions (23).…”

Section: Discussionmentioning

confidence: 99%

The Prognostic Nutritional Index May Predict Left Atrial Appendage Thrombus or Dense Spontaneous Echo Contrast in Patients With Atrial Fibrillation

Wang

et al. 2022

Front. Cardiovasc. Med.

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ObjectivesThe prognostic nutritional index (PNI) is an independent predictor of adverse outcomes in patients with cardiovascular diseases. The presence of left atrial appendage thrombus (LAAT) or spontaneous echo contrast (SEC) is associated with ischemic stroke. The present study aimed to investigate the relationship between the PNI and LAAT/dense SEC in patients with non-valvular atrial fibrillation (AF).MethodsIn patients with non-valvular AF, we compared demographics, clinical characteristics, and prevalence of LAAT/dense SEC according to the levels of the PNI. The relationship between the PNI and LAAT/dense SEC was observed.ResultsA total of 406 patients with non-valvular AF were consecutively included from March 2015 to February 2019. Of the study population, 53 patients had LAAT/dense SEC. The percentages of LAAT/dense SEC were 20.4, 14.1, and 4.5% in subjects from the lowest to the highest tertile of the PNI, respectively. Multivariate logistic analysis demonstrated that the PNI was an independent predictor for LAAT/dense SEC (OR 0.89; 95% CI, 0.82–0.97; P = 0.007). Receiver operating characteristic curve analysis revealed that the optimal cutoff value of the PNI for predicting LAAT/dense SEC was 48.0 (area under the curve: 0.68; 95% CI, 0.61–0.75; P < 0.001). The sensitivity and specificity were 83.0 and 47.6%, respectively. The risk of LAAT/dense SEC in patients with a PNI ≤ 48.0 was 2.57-fold higher than that in those with a PNI > 48.0.ConclusionThe PNI, calculated based on serum albumin and lymphocyte count, was inversely correlated with LAAT/dense SEC in patients with non-valvular AF. Therefore, it may be considered a predictor for LAAT/dense SEC.

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Section: Discussionmentioning

confidence: 99%

The Prognostic Nutritional Index May Predict Left Atrial Appendage Thrombus or Dense Spontaneous Echo Contrast in Patients With Atrial Fibrillation

Wang

et al. 2022

Front. Cardiovasc. Med.

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“…Thus, further investigations through long-term follow up data are warranted. Furthermore, a prior observational study emphasized that in patients with a higher CHA 2 DS 2 -VASc score, the possibility of not only embolic events but also left atrial appendage thrombus should be considered, even when under OAC therapy [27]. In these contexts, the current clinical guidelines emphasize that OAC treatment should be continued regardless of the maintenance of sinus rhythm [1].…”

Section: Discussionmentioning

confidence: 99%

Discontinuation of Oral Anticoagulants in Atrial Fibrillation Patients: Impact of Treatment Strategy and on Patients’ Health Status

Nakamaru,

Ikemura,

Kimura

et al. 2023

JCM

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Aims: The discontinuation of oral anticoagulants (OACs) remains as a significant concern in the management of atrial fibrillation (AF). The discontinuation rate may vary depending on management strategy, and physicians may also discontinue OACs due to concerns about patient satisfaction with their care. We aimed to assess the incidence of OAC discontinuation and its relationship to patients’ health in an outpatient AF registry. Methods and Results: From a multicenter registry for newly recognized AF patients (n = 3313), we extracted 1647 (49.7%) patients with OACs and a CHA2DS2-Vasc score of ≥2. Discontinuation was defined as sustained cessation of OACs within a 1-year follow-up. We examined predictors associated with discontinuation and its relations to health status defined by the AFEQT questionnaire. Of the 1647 patients, 385 (23.6%) discontinued OACs after 1 year, with discontinuation rates varying across treatment strategies (15.3% for catheter ablation, 4.9% for rhythm control with antiarrhythmic drugs, and 3.0% for rate control). Successful rhythm control was associated with discontinuation in the catheter ablation (OR 6.61, 95% CI 3.00–14.6, p < 0.001) and antiarrhythmic drugs (OR 6.47, 95% CI 2.62–15.9, p < 0.001) groups, whereas the incidence of bleeding events within 1 year was associated with discontinuation in the rate control group. One-year AFEQT scores did not significantly differ between patients who discontinued OACs and those who did not in each treatment strategy group. Conclusions: OAC discontinuation was common among AF patients with significant stroke risk but varied depending on the chosen treatment strategy. This study also found no significant association between OAC discontinuation and patients’ health status.

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“…[28] There is no evidence to support the risk of embolism due to thrombus shedding during anticoagulation therapy in AF patients with LAAT [Table 2]. [16,42,46,[49][50][51][52][53]…”

Section: 6%mentioning

confidence: 99%

Current Status of Left Atrial Appendage Thrombus with Atrial Fibrillation

Zhao

Zhang

2023

Cardiology Discovery

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Cardiac thrombus in patients with atrial fibrillation (AF) is most commonly found in the left atrial appendage (LAA). The incidence of LAA thrombus ranges from 1.2% to 22.6%, with the vast variation in incidence attributed to the patient’s condition. The effective rate of anticoagulation for thrombus dissolution therapy is only 50%–60%, and long-term anticoagulation treatment increases the risk of bleeding. Direct percutaneous LAA closure in AF patients with LAA thrombus in a suitable location is another alternative treatment option. LAA resection with cardiac surgery is also an effective treatment. This review presents the development of the incidence, diagnosis, and treatment of thrombus in LAA.

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Left atrial thrombus and smoke resolution in patients with atrial fibrillation under chronic oral anticoagulation

Cited by 5 publications

References 28 publications

The Prognostic Nutritional Index May Predict Left Atrial Appendage Thrombus or Dense Spontaneous Echo Contrast in Patients With Atrial Fibrillation

The Prognostic Nutritional Index May Predict Left Atrial Appendage Thrombus or Dense Spontaneous Echo Contrast in Patients With Atrial Fibrillation

Discontinuation of Oral Anticoagulants in Atrial Fibrillation Patients: Impact of Treatment Strategy and on Patients’ Health Status

Current Status of Left Atrial Appendage Thrombus with Atrial Fibrillation

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