Non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation and atrial thrombosis: An appraisal of current evidence

Calabrò, Paolo; Gragnano, Felice; Cesaro, Arturo; Marsico, Fabio; Pariggiano, Ivana; Patti, Giuseppe; Moscarella, Elisabetta; Cavallari, Ilaria; Sardu, Celestino; Parato, Vito Maurizio; Renda, Giulia; Niccoli, Giampaolo; Marcucci, Rossella; Caterina, Raffaele De

doi:10.1016/j.acvd.2020.03.019

Cited by 9 publications

(15 citation statements)

References 50 publications

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“…Although this might be a potential limitation of CT imaging, it applies to MRI as well. In addition, incidental CT findings such as LA or LAA thrombosis might influence the therapy regimen, as non-vitamin K antagonist oral anticoagulants (NOACs) are now considered as a first-line therapy in AF patients with documented LA or LAA thrombus [23]. A critical point, however, is the CT protocol.…”

Section: Discussionmentioning

confidence: 99%

Left Atrial Ejection Fraction Assessed by Prior Cardiac CT Predicts Recurrence of Atrial Fibrillation after Pulmonary Vein Isolation

Kaufmann

Rezar

Strohmer

et al. 2021

JCM

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Assuming that atrial fibrillation (AF) is associated with left atrial remodeling and dysfunction, we hypothesize that left atrial and left atrial appendage ejection fractions (LAEF and LAAEF) are useful and may be more sensitive outcome predictors of pulmonary vein isolation (PVI). Fifty patients who underwent PVI at our institution with available pre-interventional cardiac computed tomography (CT) for procedure planning were included in this retrospective study. The patients were separated into two groups by recurrence and non-recurrence of AF and subgroups of paroxysmal and persistent AF. Semiautomatic volumetric analysis of the left atrium was used to calculate morphological and functional parameters and optimal cut-offs were calculated using the Youden index. LAEF (accuracy 94%, sensitivity 67%) and LAAEF (accuracy 90%, sensitivity 67%) were significantly reduced in patients with AF recurrence (16% vs. 36%, p = 0.00002; 16% vs. 42%, p = 0.000002), and in the subgroup analysis, the functional parameters were independent from AF type (paroxysmal and persistent). With a cut-off of <23% for both LAEF and LAAEF (area under the curve (AUC) 0.94, 95%CI 0.84–0.99 and AUC 0.96, 95%CI 0.86-0.99, respectively), AF recurrence occurred in 77.8%, within a mean follow-up period of 229 days. In conclusion, left atrial function on prior cardiac CT offers useful parameters for predicting AF recurrence after PVI.

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Section: Discussionmentioning

confidence: 99%

Left Atrial Ejection Fraction Assessed by Prior Cardiac CT Predicts Recurrence of Atrial Fibrillation after Pulmonary Vein Isolation

Kaufmann

Rezar

Strohmer

et al. 2021

JCM

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“…However, the evidence on the treatment DRT is still scarce. 38 One small-scale study described a recurrence of DRT, and the rate was 35%. 39 While, applying antithrombotic therapy to dissolve a DRT may increase the risk of a bleeding complication; therefore, the treatment of DRT still needs to be investigated carefully.…”

Section: Discussionmentioning

confidence: 99%

Device-Related Thrombosis in Patients Receiving One-Stop Intervention for Nonvalvular Atrial Fibrillation: A Systemic Review and Meta-Analysis

Tang

Zhang

2021

Clin Appl Thromb Hemost

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This study aimed to assess the incidence, clinical implications, and treatment strategies of device-related thrombus (DRT) following catheter ablation and percutaneous left atrial appendage occlusion combined in one intervention. A meta-analysis of observational studies was conducted to evaluate the incidence rates, treatment strategies, and clinical implications of DRT. A total of 21 studies describing DRT events and 1 case were included in the current study. The 21 included studies comprised 3 multi-center registries and 18 single-center registries, and we also included 1 case report analyzing the characteristics of DRT. The pooled incidence of DRT in one-stop intervention was 18/1,708 (1.2%; range = 0%-7.3%; 95% CI = 0.7%-1.8%; I 2 = 0). Of these DRT events, 56.25% were diagnosed in the first 3 months after the procedure. All cases were diagnosed via trans-esophagus echocardiogram. All of the patients diagnosed with DRT were prescribed anticoagulation treatment, and 63% (12/19) of the events were reported with an outcome of complete thrombus resolution. The duration of anticoagulation treatment varied greatly, from 30 days to 6 months. Unknown clinical events were reported relating to DRT. Device-related thrombus is an uncommon complication of one-stop intervention. It occurs mainly in the early period following the procedure. Anticoagulation appears to be an appropriate treatment method for dissolving occurrences of DRT.

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“…Although warfarin has a broader range of indications, this advantage continues to abate, as DOACs continue to be studied. For example, recent studies have shown that DOACs are an effective anticoagulant for patients diagnosed with atrial fibrillation and atrial thrombus [17]. Disadvantages include expensive reversal agents, increased rate of adverse events in patients with chronic kidney disease (CKD) and liver disease, and a less broad range of indications than warfarin.…”

Section: Advantages and Disadvantages Of Warfarin And Direct Oral Anticoagulantsmentioning

confidence: 99%

The Effects of Warfarin and Direct Oral Anticoagulants on Systemic Vascular Calcification: A Review

Elango

Javaid

Khetarpal

et al. 2021

Cells

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Warfarin has been utilized for decades as an effective anticoagulant in patients with a history of strong risk factors for venous thromboembolism (VTE). Established adverse effects include bleeding, skin necrosis, teratogenicity during pregnancy, cholesterol embolization, and nephropathy. One of the lesser-known long-term side effects of warfarin is an increase in systemic arterial calcification. This is significant due to the association between vascular calcification and cardiovascular morbidity and mortality. Direct oral anticoagulants (DOACs) have gained prominence in recent years, as they require less frequent monitoring and have a superior side effect profile to warfarin, specifically in relation to major bleeding. The cost and lack of data for DOACs in some disease processes have precluded universal use. Within the last four years, retrospective cohort studies, observational studies, and randomized trials have shown, through different imaging modalities, that multiple DOACs are associated with slower progression of vascular calcification than warfarin. This review highlights the pathophysiology and mechanisms behind vascular calcification due to warfarin and compares the effect of warfarin and DOACs on systemic vasculature.

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Non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation and atrial thrombosis: An appraisal of current evidence

Cited by 9 publications

References 50 publications

Left Atrial Ejection Fraction Assessed by Prior Cardiac CT Predicts Recurrence of Atrial Fibrillation after Pulmonary Vein Isolation

Left Atrial Ejection Fraction Assessed by Prior Cardiac CT Predicts Recurrence of Atrial Fibrillation after Pulmonary Vein Isolation

Device-Related Thrombosis in Patients Receiving One-Stop Intervention for Nonvalvular Atrial Fibrillation: A Systemic Review and Meta-Analysis

The Effects of Warfarin and Direct Oral Anticoagulants on Systemic Vascular Calcification: A Review

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