Treatment of Persistent Left Atrial Appendage Thrombus in Patients with Atrial Fibrillation on Adequate Oral Anticoagulation: Pathways of Care for All-comers and Heart Failure Patients

Katić, Josip; Borovac, Josip Anđelo

doi:10.15420/cfr.2022.28

Cited by 4 publications

(3 citation statements)

References 65 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Furthermore, the CCTA detection of a thrombus in the LAA further complicates the clinical scenario and was managed with low-molecular heparin: OAC, the most adopted treatment of LAA thrombus, 11 was not considered due to the bleeding history.…”

Section: Discussionmentioning

confidence: 99%

A giant left atrial appendage: a case report on the feasibility of closure with a custom-made device

Barocelli,

Gurgoglione,

Covani

et al. 2023

European Heart Journal - Case Reports

View full text Add to dashboard Cite

Background Transcatheter left atrial appendage occlusion (LAAO) is a valuable therapeutic option for stroke prevention in patients with atrial fibrillation (AF) at high bleeding risk. However, complex LAA anatomies sometimes preclude the adoption of commercially available LAAO devices. The design of a custom-made LAAO device is a promising strategy in these cases. However, few examples of custom-made devices in case of giant LAAs have been reported. Case summary An 85-year-old man with permanent AF with CHA2DS2-VASc 4 and recurrent active gastrointestinal major bleedings was referred for transcatheter LAAO at Parma University Hospital after multidisciplinary team evaluation. Pre-procedural coronary computed tomography angiography revealed a giant windsock LAA, with a maximum ostium diameter of 44 mm, a landing zone diameter of 34 mm, and maximal length of 49 mm. Patient’s management was particularly challenging given that available LAAO devices were too small to completely exclude the LAA. In accordance with the manufacturer, a custom-made LAmbre™ Closure System (Lifetech Scientific, Shenzhen, China), which specifically fitted with patient’s LAA anatomy, was designed and successfully deployed under transoesophageal echocardiography (TEE) and fluoroscopic guidance. Periprocedural TEE confirmed the appropriate position of the device and the absence of peri-device leaks. No adverse ischaemic and haemorrhagic events were reported at 3-months follow-up. Discussion We present a case of a successful transcatheter LAAO procedure by deploying a custom-made LAmbre device 38/46 mm to mechanically exclude a giant windsock LAA. This case illustrates the effectiveness of a custom-made device strategy, which potentially enables the closure of all complex LAA anatomies.

show abstract

Section: Discussionmentioning

confidence: 99%

A giant left atrial appendage: a case report on the feasibility of closure with a custom-made device

Barocelli,

Gurgoglione,

Covani

et al. 2023

European Heart Journal - Case Reports

View full text Add to dashboard Cite

show abstract

“…The LAA peak flow velocity (LAAFV), assessed by transoesophageal echocardiography (TEE), is an established quantitative parameter for estimating LA thrombi and thromboembolic events. 4 , 5 , 9–12 A reduced LAAFV reflects blood slowing or pooling within the LAA. An increased prevalence of LA thrombi in patients with reduced LAAFV illustrates how ‘blood stasis’ is an important contributor to the development of LA thrombi.…”

Section: Introductionmentioning

confidence: 99%

Impact of left atrial appendage flow velocity on thrombus resolution and clinical outcomes in patients with atrial fibrillation and silent left atrial thrombi: insights from the LAT study

Okada,

Inoue,

Tanaka

et al. 2024

Europace

View full text Add to dashboard Cite

Aims Blood stasis is crucial in developing left atrial (LA) thrombi. LA appendage peak flow velocity (LAAFV) is a quantitative parameter for estimating thromboembolic risk. However, its impact on LA thrombus resolution and clinical outcomes remains unclear. Methods and Results The LAT study was a multicenter observational study investigating patients with atrial fibrillation (AF) and silent LA thrombi detected by transesophageal echocardiography (TEE). Among 17,436 TEE procedures for patients with AF, 297 patients (1.7%) had silent LA thrombi. Excluding patients without follow-up examinations, we enrolled 169 whose baseline LAAFV was available. Oral anticoagulation use increased from 85.7% at baseline to 97.0% at the final follow-up (p < 0.001). During 1-year, LA thrombus resolution was confirmed in 130 (76.9%) patients within 76 (34–138) days. Conversely, 26 had residual LA thrombi, 8 had thromboembolisms, and 5 required surgical removal. These patients with failed thrombus resolution had lower baseline LAAFV than those with successful resolution (18.0 [15.8–22.0] vs. 22.2 [17.0–35.0], p = 0.003). Despite limited predictive power (area under the curve, 0.659; p = 0.001), LAAFV ≤20.0 cm/s (best cutoff) significantly predicted failed LA thrombus resolution, even after adjusting for potential confounders (odds ratio, 2.72; 95% confidence interval, 1.22–6.09; p = 0.015). The incidence of adverse outcomes including ischemic stroke/systemic embolism, major bleeding, or all-cause death was significantly higher in patients with reduced LAAFV than in those with preserved LAAFV (28.4% vs. 11.6%, log-rank p = 0.005). Conclusions Failed LA thrombus resolution was not rare in patients with AF and silent LA thrombi. Reduced LAAFV was associated with failed LA thrombus resolution and adverse clinical outcomes.

show abstract

“…Left atrial appendage (LAA) constitutes a critical of thrombosis in patients with atrial fibrillation (AF) [ 1 ]. More than 90% of thrombus in patients with nonvalvular atrial fibrillation (NVAF) originates from LAA, prompting the consideration of left atrial appendage closure (LAAC) as an alternative approach for stroke prevention in patients with NVAF [ 2 , 3 ].…”

Section: Introductionmentioning

confidence: 99%

Perioperative Treatment with Rivaroxaban and Dabigatran on Changes of Coagulation and Platelet Activation Biomarkers following Left Atrial Appendage Closure

Yao,

Li,

Jin

et al. 2024

Cardiovascular Therapeutics

View full text Add to dashboard Cite

Insufficient data exist regarding the investigation of the impact of novel oral anticoagulants (NOACs) on coagulation activation biomarkers in the context of left atrial appendage closure (LAAC) and device-related thrombosis (DRT). The study was designed to investigate the changes and presence of coagulation activation biomarkers between different antithrombotic strategies following LAAC. A total of 120 nonvalvular atrial fibrillation patients intolerant of long-term anticoagulants, who underwent successful WATCHMAN closure implantation, were enrolled (rivaroxaban, n=82; dabigatran, n=38). Blood samples were obtained from left atrium (LA) and left atrial appendage (LAA) during the operation and fasting blood samples on the same day of LAAC and 45 days after discharge. The biochemical indicators, thrombin-antithrombin complex (TAT), soluble P-selectin (sP-selectin), von Willebrand factor (vWF), and CD40 ligand (CD40L), were measured by enzyme-linked immunosorbent assay. The primary endpoints of this study were the efficacy and safety characteristics of different antithrombotic strategies, including DRT incidence, stroke or transient ischemic attack, systemic embolism, and clinical major and nonmajor bleeding complications during the follow-up of 180 days. The results revealed that TAT, vWF, sP-selectin, and CD40L levels in vein were significantly reduced by 2.4% (p=0.043), 5.0% (p<0.001), 8.7% (p<0.001), and 2.5% (p=0.043) from their baseline levels after rivaroxaban treatment. Conversely, no significant changes were detected in the dabigatran group. Furthermore, the plasma levels of platelet activation biomarkers (CD40L and sP-selectin) in both LA and LAA groups were significantly lower after anticoagulation with rivaroxaban, as compared to dabigatran treatment (CD40L: 554.62±155.54 vs. 445.02±130.04 for LA p=0.0013, 578.51±156.28 vs. 480.13±164.37 for LAA p=0.0052; sP-selectin: 2849.07±846.69 vs. 2225.54±799.96 for LA p=0.0105, 2915.52±1402.40 vs. 2203.41±1061.67 for LAA p=0.0022). Notably, the present study suggests that rivaroxaban may be more effective in the prevention of DRT for patients undergoing LAAC.

show abstract

Treatment of Persistent Left Atrial Appendage Thrombus in Patients with Atrial Fibrillation on Adequate Oral Anticoagulation: Pathways of Care for All-comers and Heart Failure Patients

Cited by 4 publications

References 65 publications

A giant left atrial appendage: a case report on the feasibility of closure with a custom-made device

A giant left atrial appendage: a case report on the feasibility of closure with a custom-made device

Impact of left atrial appendage flow velocity on thrombus resolution and clinical outcomes in patients with atrial fibrillation and silent left atrial thrombi: insights from the LAT study

Perioperative Treatment with Rivaroxaban and Dabigatran on Changes of Coagulation and Platelet Activation Biomarkers following Left Atrial Appendage Closure

Contact Info

Product

Resources

About