Left atrial thrombus in patients with atrial fibrillation and under oral anticoagulant therapy; 3-D transesophageal echocardiographic study

Prevalence of left atrial thrombus by real time three‐dimensional echocardiography in patients undergoing electrical cardioversion of atrial fibrillation: A contemporary cohort study

“…In the recent series by Durmaz et al, the presence of thrombus at the TEE was significantly associated with future ischemic stroke despite anticoagulant therapy. In our study, one of the patients with thrombus had a stroke within 4 weeks despite ECV was deferred 15 …”

“…The degree of SEC, low LVEF, and ineffective anticoagulation were all associated with the presence of the thrombus at the RT3D‐TEE. CHA 2 DS 2 VASc was associated with thrombus in patients who were adequately anticoagulated, this provides some insight to reconcile controversial findings on the role of CHA 2 DS 2 VASc 7,8,15 …”

“…These methodological considerations explain the wide range of thrombus prevalence reported in the literature ranging from 0% to 18% in patients under oral anticoagulant treatment before elective ECV 15–18 …”

“…CHA 2 DS 2 VASc was associated with thrombus in patients who were adequately anticoagulated, this provides some insight to reconcile controversial findings on the role of CHA 2 DS 2 VASc. 7,8,15 The presence of a thrombus is a contraindication to ECV 4 and once a clot is detected the procedure is canceled or deferred.…”

“…These methodological considerations explain the wide range of thrombus prevalence reported in the literature ranging from 0% to 18% in patients under oral anticoagulant treatment before elective ECV. [15][16][17][18] In addition, in real-life practice, the effectiveness of oral anticoagulation is not universal. In the study by Fukuda et al 19 of 231consecutive patients with nonvalvular AF scheduled for ECV and treated with warfarin, target INR was achieved in 35% and in these the prevalence of thrombus was 3.6%, which is similar to our study.…”