Outcome of non‐vitamin K oral anticoagulants in the treatment of left atrial/left atrial appendage thrombus in patients with nonvalvular atrial fibrillation

Abstract

Background Data comparing dabigatran with rivaroxaban regarding the resolution of left atrial/left atrial appendage (LA/LAA) thrombus in patients with nonvalvular atrial fibrillation (AF) are scarce. This study aimed to compare the efficacy and safety of dabigatran vs rivaroxaban regarding the resolution of LA/LAA thrombus in patients with nonvalvular AF. Methods This retrospective study enrolled nonvalvular AF patients scheduled to undergo catheter ablation or cardioversion in Shanghai Ruijin Hospital between January 2014 and January 2019. Altogether, 34 patients with LA/LAA thrombus detected by transesophageal echocardiography (TEE) were enrolled. Among them, 12 patients were treated with dabigatran 150 mg bid and the other 22 with rivaroxaban 20 mg qd. Follow‐up TEE was performed within greater than or equal to 3 weeks to less than 6 months of the initial TEE to evaluate the resolution of the LA/LAA thrombus. Results Baseline patient characteristics were similar in the two groups. Overall, 18 patients (81.8%) in the rivaroxaban group had complete thrombus resolution after 70.3 ± 22.1 treatment days, and 10 patients (83.3%) in the dabigatran group had complete thrombus resolution after 69.3 ± 47.9 treatment days. There was no significant difference between the groups (P = .6). TEE showed that the average length, width, and area of thrombus significantly decreased in both groups after treatment, although there was no significant difference in the amount of change in these parameters between the two groups after treatment (P = .6). Undissolved thrombus in two patients in the rivaroxaban group did dissolve after switching to dabigatran. Conclusions The results suggest that both dabigatran and rivaroxaban are potential options for treating LA/LAA thrombus in patients with nonvalvular AF. Dabigatran could be an alternative option for the resolution of LA/LAA thrombus resistant to rivaroxaban.

Prevalence, predictors and management of left atrial appendage thrombogenic milieu in atrial fibrillation with low thromboembolic risk

“…Short-term OAC, including NOACs and VKA, has long been used to resolve LAAT or sludge in patients with NVAF. Previous studies investigating the efficacy of NOACs or AVK showed conflicting results with the resolution rate of LAAT ranging from 41.5-85.7% [14,[20][21][22][23][24]. However, in the present study, all LAATs or sludges effectively resolved after OAC medication of 3-4 months, whether standard-dose NOAC, reduceddose NOAC or VKA (TTR ranging from 60 to 75%).…”

“…Previous study demonstrated that the patients with LAAT resolution had lower CHA 2 DS 2 -VASc scores [22]. In addition, the overall resolution rate is obviously higher in the Asian race [22][23][24]. The racial disparity of effectiveness and safety with OAC has been discussed in various studies.…”

The Safety and Efficacy of Standard-Dose versus Low-Dose Non-Vitamin K Antagonist Oral Anticoagulants in Patients with Nonvalvular Atrial Fibrillation and Left Atrial Appendage Thrombus

“…Another follow-up TEE was performed at 12 weeks, with complete resolution observed in 32 (80%) and 28 (70%) subjects in the rivaroxaban group and warfarin group, respectively ( P = 0.302). Lin et al 6 included 34 patients with LA/LAAT and treated with NOACs (12 dabigatran and 22 rivaroxaban). Finally, thrombus resolution was achieved in 83.3% and 81.8% of patients treated with dabigatran and rivaroxaban, respectively.…”

“…Low-dose NOACs in Asian population showed noninferior safety and efficacy in stroke prevention compared with standard-dose NOACs [ 3 , 4 ]. Previous investigations indicated that standard-dose NOACs were effective in LAAT resolution [ 5 , 6 ]. Ke et al [ 5 ] compared the efficacy and safety on the resolution of LA/LAA thrombus between rivaroxaban and warfarin.…”

“…They found that rivaroxaban 20 mg was more effective than warfarin on the resolution of LA/LAA thrombus in nonvalvular AF patients especially after 6-week treatments. Lin et al [ 6 ] found that both dabigatran and rivaroxaban (81.8% vs. 83.3% complete resolution) are potential options for treating LA/LAA thrombus in patients with nonvalvular AF. However, the safety and efficacy for the treatment of LAAT by low-dose NOACs compared to standard-dose NOACs were still unknown.…”