Left Atrial Thrombus in Atrial Fibrillation/Flutter Patients in Relation to Anticoagulation Strategy: LATTEE Registry

Abstract

Background: Atrial fibrillation (AF) and flutter (AFl) increase the risk of thromboembolism. The aim of the study was to assess the prevalence of left atrial thrombus (LAT) in AF/AFl in relation to oral anticoagulation (OAC). Methods: LATTEE (NCT03591627) was a multicenter, prospective, observational study enrolling consecutive patients with AF/AFl referred for transesophageal echocardiography before cardioversion or ablation. Results: Of 3109 patients enrolled, 88% were on chronic, 1.5% on transient OAC and 10% without OAC. Of patients on chronic OAC, 39% received rivaroxaban, 30% dabigatran, 14% apixaban and 18% vitamin K antagonists (VKA). Patients on apixaban were oldest, had the worst renal function and were highest in both bleeding and thromboembolic risk, and more often received reduced doses. Prevalence of LAT was 8.0% (7.3% on chronic OAC vs. 15% without OAC; p < 0.01). In patients on VKA, prevalence of LAT was doubled compared to patients on non-VKA-OACs (NOACs) (13% vs. 6.0%; p < 0.01), even after propensity score weighting (13% vs. 7.5%; p < 0.01). Prevalence of LAT in patients on apixaban was higher (9.8%) than in those on rivaroxaban (5.7%) and dabigatran (4.7%; p < 0.01 for both comparisons), however, not after propensity score weighting. Conclusions: The prevalence of LAT in AF is non-negligible even on chronic OAC. The risk of LAT seems higher on VKA compared to NOAC, and similar between different NOACs.

Left Atrial Appendage Thrombosis and Oral Anticoagulants: A Meta-Analysis of Risk and Treatment Response

“…These studies were published between 2016 and 2022. Among the studies, four were conducted in Poland [ 27 , 29 , 30 , 33 ], two were conducted in Japan [ 25 , 32 ], two were conducted in the United States [ 24 , 28 ], and one was conducted each in the EU [ 26 ], Germany [ 31 ], Canada [ 21 ], Turkey [ 23 ], and Italy [ 22 ]. The selected studies were mostly conducted in Western countries, and only two were conducted in an Asian population (Japan).…”

“…The selected studies were mostly conducted in Western countries, and only two were conducted in an Asian population (Japan). Six studies were prospective [ 21 , 22 , 23 , 26 , 29 , 33 ], and seven were retrospective [ 24 , 25 , 27 , 28 , 30 , 31 , 32 ].…”

Risk factors for left atrial thrombus in younger patients (aged < 65 years) with atrial fibrillation or atrial flutter: Data from the multicenter left atrial thrombus on transesophageal echocardiography (LATTEE) registry

“…In total, 3,109 AF or AFl patients were included in the study. Detailed data about the entire LATTEE registry group were included in previous manuscripts ( 9 , 10 ).…”

“…The reasons for admission were catheter ablation or cardioversion and TEE performed directly before the procedure. The methods of the study were previously described in detail ( 9 , 10 ). Briefly, consecutive hospitalized patients diagnosed with AF/AFl who underwent TEE before direct current cardioversion or catheter ablation were included in the registry.…”

Echocardiographic predictors of thrombus in left atrial appendage—The role of novel transthoracic parameters

“…The study is a sub-analysis of the real-world Left Atrial Thrombus on Transesophageal Echocardiography (LATTEE) registry (NCT03591627), which evaluated the determinants of LAAT depending on echocardiographic and clinical parameters in patients with AF/AFL referred for electrical cardioversion or catheter ablation. Exact details on the study rationale and design have been published previously ( 12 ), while the primary data concerning the prevalence of a thrombus depending on anticoagulation strategy were further precisely delineated ( 13 ). In sum, the LATTEE was a prospective, observational study enrolling consecutive patients with AF/AFL admitted to 13 cardiology departments between November 2018 and May 2020 in whom TEE was performed before direct current cardioversion or catheter ablation.…”