Characteristics of non-valvular atrial fibrillation with left atrial appendage thrombus who are undergoing appropriate oral anticoagulation therapy

Shiraki, Hiroaki; Tanaka, Hidekazu; Yamauchi, Yuki; Yoshigai, Yuko; Yamashita, Kentaro; Tanaka, Yusuke; Sumimoto, Keiko; Shono, Ayu; Suzuki, Makiko; Yokota, Shun; Matsumoto, Kensuke; Fukuzawa, Koji; Hirata, Ken‐ichi

doi:10.1007/s10554-021-02403-z

Cited by 6 publications

(17 citation statements)

References 25 publications

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“…These studies were published between 2016 and 2022. Among the studies, four were conducted in Poland [ 27 , 29 , 30 , 33 ], two were conducted in Japan [ 25 , 32 ], two were conducted in the United States [ 24 , 28 ], and one was conducted each in the EU [ 26 ], Germany [ 31 ], Canada [ 21 ], Turkey [ 23 ], and Italy [ 22 ]. The selected studies were mostly conducted in Western countries, and only two were conducted in an Asian population (Japan).…”

Section: Resultsmentioning

confidence: 99%

“…The selected studies were mostly conducted in Western countries, and only two were conducted in an Asian population (Japan). Six studies were prospective [ 21 , 22 , 23 , 26 , 29 , 33 ], and seven were retrospective [ 24 , 25 , 27 , 28 , 30 , 31 , 32 ].…”

Section: Resultsmentioning

confidence: 99%

“…The studies included different parameters for predicting the risk of LAAT. A higher CHA2DS2-VASc score [ 22 , 23 , 25 , 33 ], reduced left ventricular ejection fraction [ 22 , 23 , 27 , 33 ], reduced left atrial flow velocity [ 23 , 25 , 30 , 32 ], reduced B-type natriuretic peptide, and larger left atrium [ 25 ] were associated with the risk of LAAT. The demographic predictors of the risk of LAAT included aging, a lower body weight, lower creatinine clearance, heart failure, and diuretic treatment were also listed.…”

Section: Resultsmentioning

confidence: 99%

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Left Atrial Appendage Thrombosis and Oral Anticoagulants: A Meta-Analysis of Risk and Treatment Response

Cheng

Tan

Hong

et al. 2022

JCDD

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Background: Left atrial appendage thrombus (LAAT) is the main cause of cardioembolism in patients with nonvalvular atrial fibrillation (AF). Emerging evidence indicates that direct oral anticoagulants (DOACs) may be a preferred, safer choice for patients with LAAT. However, current guidelines indicate vitamin K antagonist (VKA) as the preferred treatment for LAAT. We conducted a meta-analysis to compare the efficacy of VKA and DOAC for the treatment of LAAT. Methods: The search was conducted in the PubMed, Embase, Google Scholar, and Cochrane Library databases from inception to July 2022, with the language restricted to English. A first analysis was conducted to evaluate the risk of LAAT under VKA or DOAC treatment. A second analysis was conducted to compare the resolution of LAAT under VKA and DOAC treatment. Results: In 13 studies comparing LAAT incidence rates under VKA and DOAC treatment, significant superiority of DOAC was detected (pooled RR = 0.65, 95% CI = 0.47–0.90, p = 0.009) with moderate heterogeneity being identified in the pooled studies. In 13 studies comparing LAAT resolution under VKA and DOAC use, treatment with DOAC exhibited a significantly increased probability of LAAT resolution compared with VKA (pooled odds ratio = 1.52, 95% CI = 1.02–2.26, p = 0.040). Conclusions: This meta-analysis suggests a superiority of DOAC over VKA with respect to LAAT incidence in people with AF and the likelihood of LAAT resolution. Due to their established safety profile, DOAC is a preferable choice for anticoagulation, although further randomized controlled studies are warranted to provide further evidence of their suitability as a new recommended treatment.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Left Atrial Appendage Thrombosis and Oral Anticoagulants: A Meta-Analysis of Risk and Treatment Response

Cheng

Tan

Hong

et al. 2022

JCDD

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“…8-12 Furthermore, a recent study by Shiraki et al found that LAVI as a parameter of transthoracic echocardiography in multivariate logistic regression analysis was the only independent predictor of LAA thrombus formation for 737 patients with non-valvular AF who had received appropriate oral anticoagulation therapy. 11 Shiraki et al also showed that the prevalence of LAA thrombus formation in AF patients with LAVI ≥50 mL/m 2 was high as 8.7%. 11 Thus, transcatheter or surgical LAA occlusion may be another therapeutic strategy to avoid thromboembolism in AF patients with a larger LAVI.…”

Section: Discussionmentioning

confidence: 95%

Association of Left Atrial Size With Stroke or Systemic Embolism in Patients With Atrial Fibrillation Having Undergone Bioprosthetic Valve Replacement From the BPV-AF Registry

et al. 2023

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Background:The left atrial volume index (LAVI) is important for predicting thromboembolism in patients with non-valvular atrial fibrillation (AF), but the utility of LAVI for predicting thromboembolism in patients with both bioprosthetic valve replacement and AF remains unclear. Methods and Results:Of 894 patients from a previous multicenter prospective observational registry (BPV-AF Registry), 533 whose LAVI data had been obtained by transthoracic echocardiography were included in this subanalysis. Patients were divided into tertiles (T1-T3) according to LAVI as follows: T1 (n=177), LAVI=21.5-55.3 mL/m 2 ; T2 (n=178), LAVI=55.6-82.1 mL/m 2 ; T3 (n=178), LAVI=82.5-408.0 mL/m 2 . The primary outcome was defined as either stroke or systemic embolism for a mean (±SD) follow-up period of 15.3±4.2 months. Kaplan-Meier curves indicated that the primary outcome tended to occur more frequently in the group with the larger LAVI (log-rank P=0.098). Comparison of T1 with T2 plus T3 using Kaplan-Meier curves indicated that patients in T1 experienced significantly fewer primary outcomes (log-rank P=0.028). Furthermore, univariate Cox proportional hazard regression showed that 1.3-and 3.3-fold more primary outcomes occurred in T2 and T3, respectively, than in T1. Conclusions:Larger LAVI was associated with stroke or systemic embolism in patients who had undergone bioprosthetic valve replacement and with a definitive diagnosis of AF.

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“…4 In addition, LA enlargement in AF patients is associated with the development of HF or thromboembolism. [5][6][7][8][9][10] Mitral regurgitation (MR), and a recently recognized disease entity known as atrial functional mitral regurgitation (AFMR), occurs due to mitral annular dilatation with LA enlargement in AF patients and is closely related to prognosis. [7][8][9][10] Catheter ablation is a currently well-established treatment for AF patients to prevent adverse events such as the development of HF or stroke.…”

Section: Introductionmentioning

confidence: 99%

Identification of factors associated with progression of left atrial enlargement in patients with atrial fibrillation

et al. 2023

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Left atrial (LA) enlargement frequently occurs in atrial fibrillation (AF) patients, and this enlargement is associated with the development of heart failure, thromboembolism, or atrial functional mitral regurgitation (AFMR). AF patients can develop LA enlargement over time, but its progression depends on the individual. So far, the factors that cause progressive LA enlargement in AF patients have thus not been elucidated, so that the aim of this study was to identify the factors associated with the progression of LA enlargement in AF patients. We studied 100 patients with persistent or permanent AF (aged: 67 ± 2 years, 40 females). Echocardiography was performed at baseline and 12 (5–30) months after follow‐up. LA size was evaluated as the LA volume index which was calculated with the biplane modified Simpson's method from apical four‐and two‐chamber views, and then normalized to the body surface area (LAVI). The deterioration of AFMR after follow‐up was defined as a deterioration in severity of mitral regurgitation (MR) by a grade of 1 or more. Multivariate regression analysis demonstrated that hypertension (p = .03) was an independently associated parameter of progressive LA enlargement, as was baseline LAVI. In addition, the Kaplan–Meier curve indicated that patients with hypertension tended to show greater deterioration of AFMR after follow‐up than those without hypertension (log‐rank p = .08). Hypertension proved to be strongly associated with progression of LA enlargement over time in patients with AF. Our findings provide new insights for better management of patients with AF to prevent the development of AFMR.

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Characteristics of non-valvular atrial fibrillation with left atrial appendage thrombus who are undergoing appropriate oral anticoagulation therapy

Cited by 6 publications

References 25 publications

Left Atrial Appendage Thrombosis and Oral Anticoagulants: A Meta-Analysis of Risk and Treatment Response

Left Atrial Appendage Thrombosis and Oral Anticoagulants: A Meta-Analysis of Risk and Treatment Response

Association of Left Atrial Size With Stroke or Systemic Embolism in Patients With Atrial Fibrillation Having Undergone Bioprosthetic Valve Replacement From the BPV-AF Registry

Identification of factors associated with progression of left atrial enlargement in patients with atrial fibrillation

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