Prevalence and Resolution of Left Atrial Thrombus in Patients With Nonvalvular Atrial Fibrillation and Flutter With Oral Anticoagulation

Niku, Adam; Shiota, Takahiro; Siegel, Robert J.; Rader, Florian

doi:10.1016/j.amjcard.2018.09.027

Cited by 51 publications

(48 citation statements)

References 28 publications

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“…Eventually, we concluded that history of diabetes and thrombus mobility were the main factors associated with the occurrence of ST. This result was consistent with those presented in Adam's real-world observational study, which identified history of diabetes as the only determinant of thrombus persistence through multivariate analysis [2]. This finding may reflect the fact that coagulation disorders induced by hyperglycemia and insulin resistance increase thrombotic risk.…”

Section: Discussionsupporting

confidence: 92%

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Risk factors for systemic thromboembolism after left chamber cardiac thrombi --- A retrospective multi-center study

zhou

Shi

et al. 2019

Preprint

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Background : We aimed to characterize the independent predictors of systemic thromboembolism (ST) after left chamber thrombi. Methods: A retrospective analysis on the medical records of 175 patients diagnosed with left chamber thrombi by transthoracic echocardiography (TTE) at three centers were carried out. Multivariate logistic regression was performed to determine the relationship of each characteristic with ST. Multivariate Cox proportional survival analysis was conducted, with covariate adjustments, to identify predictors of all-cause mortality. Results: During a median 42 months of follow-up (25th–75th percentile: 20–62 months), 24 (13.7%) patients had ST, and 62 (35.4%) died. History of diabetes and thrombus mobility were independent predictors of ST (P = 0.003, P = 0.02, respectively). There was a significant association between abnormal ejection fraction (EF) and all-cause mortality (P = 0.003). Conclusions: The morbidity associated with ST and the increased risk for mortality associated with left chamber cardiac thrombi relates to medical history, thrombus state, and diminished heart function.

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Section: Discussionsupporting

confidence: 92%

“…So although few studies have investigated NOAC treatment for the prophylaxis and resolution of intracardiac thrombi [2,[4][5][6][7], considering the low rate of thromboembolic or hemorrhagic complications, NOAC may be a safe and effective therapeutic alternative for intracardiac thrombi [5,8].…”

Section: Discussionmentioning

confidence: 99%

Risk factors for systemic thromboembolism after left chamber cardiac thrombi --- A retrospective multi-center study

zhou

Shi

et al. 2019

Preprint

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“…In the lack of definitive data, the usual treatment of LAAT is a continued or intensified OAC. However, a recent study with sequential TEE in patients with a LAAT revealed that 41% of LAAT do not resolve despite anticoagulation therapy . Because LAA thrombi are associated with a rate of stroke or systemic embolization of 10% per year despite VKA, alternative strategies are needed.…”

Section: Discussionmentioning

confidence: 99%

“…However, a recent study with sequential TEE in patients with a LAAT revealed that 41% of LAAT do not resolve despite anticoagulation therapy. 7…”

Section: Rationale Of Laac Despite Laatmentioning

confidence: 99%

Percutaneous left atrial appendage closure in the presence of thrombus: A feasibility report

Bordignon

Bologna

Chen

et al. 2019

Cardiovasc electrophysiol

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Background Patients with a left atrial appendage thrombus (LAAT) despite oral anticoagulation (OAC) are at high risk of thromboembolism (TE) and a relevant proportion of LAAT do not resolve under continued OAC. Left atrial appendage closure (LAAC) in the presence of LAAT was anecdotally described as a therapeutic option to prevent TE in the patients. Objective To describe the feasibility of LAAC despite LAAT in consecutive patients. Methods We searched the LAAC database of our center to identify patients in whom a LAAC was performed despite evidence of a thrombus in the LAA. All procedures were performed under transesophageal echocardiography guidance, no angiographies were performed to avoid LAAT dislocation. An Amulet Occluder device was preferred to allow proximal implantation and sealing of the LAA. Results Nine patients were identified. The mean age was 68.1 ± 10.7 years, four were female, mean CHADSVASC and HASBLED were 3.6 ± 1.7 and 3.0 ± 1.0. Eight of nine patients were on OAC, one patient was under lone aspirin therapy because of bleeding. The mean distance between the LAAT and the estimated landing zone was 18 ± 6 mm, the minimal distance was 11 mm. The mean landing zone was 21 ± 3 mm, devices with a mean size of 25 ± 4 mm were chosen for implantation. All implantation succeeded, only two patients required an intraprocedural replacement. No procedural complication nor short term thromboembolic complication during a follow up of 138 ± 149 days were recorded. Conclusion In the presented series a percutaneous LAAC despite a LAAT resulted to be feasible and safe.

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“…Despite their effectiveness, patients with perceived or absolute contraindication to OACs due to the risk of bleeding cannot benefit from this therapy. For these patients, LAAO has emerged as a nonpharmacological alternative for the prevention of stroke [6,7]. The two devices most commonly used in clinical practice are the Watchman® and Amulet® (Amplatzer) devices, but randomized studies are only available for the Watchman device [8].…”

Section: Introductionmentioning

confidence: 99%

Comparison Between Oral Anticoagulation and Left Atrial Appendage Occlusion in the Prevention of Stroke With Regard to Non-Valvular Atrial Fibrillation

Sandhu¹,

Aftab²,

Anthony³

et al. 2020

Cureus

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In the past, the most common type of atrial fibrillation leading to stroke was valvular; this was predominantly due to the prevalence of rheumatic fever, but with the advent of better-hospitalized care, the cases of valvular atrial fibrillation declined. In recent years, there has been an increase in cases of stroke due to non-valvular atrial fibrillation. Stasis of blood in the left atrial pouch leads to coagulation and thrombi formation, which may lead to stroke. Oral medication or mechanical intervention can prevent thrombi formation. Both oral anticoagulation and left atrial appendage occlusion (LAAO) have been compared to see which has better outcomes. It was observed that LAAO has greater efficacy, but with time throughout a couple of years, no considerable difference was seen when compared to warfarin. Most of the long-term randomized controlled trials have been performed with the Watchman ® device. Although the Lariat and Amplatzer LAAO devices have also shown favorable outcomes, there is still a deficiency when it comes to trials of high-quality evidence using these devices as an intervention. Dual therapy with both of these approaches showed a decline in the count of major bleeding episodes on follow-up. Overall, albeit both methods have proven useful, LAAO has a slight advantage in efficacy and leads to less hemorrhagic events.

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Prevalence and Resolution of Left Atrial Thrombus in Patients With Nonvalvular Atrial Fibrillation and Flutter With Oral Anticoagulation

Cited by 51 publications

References 28 publications

Risk factors for systemic thromboembolism after left chamber cardiac thrombi --- A retrospective multi-center study

Risk factors for systemic thromboembolism after left chamber cardiac thrombi --- A retrospective multi-center study

Percutaneous left atrial appendage closure in the presence of thrombus: A feasibility report

Comparison Between Oral Anticoagulation and Left Atrial Appendage Occlusion in the Prevention of Stroke With Regard to Non-Valvular Atrial Fibrillation

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