Clinical outcomes and thrombus resolution in patients with solid left atrial appendage thrombi: results of a single-center real-world registry

Nelles, Dominik; Lambers, Moritz; Schafigh, Myriam; Morais, Pedro; Schueler, Robert; Vij, Vivian; Tiyerili, Vedat; Weber, Marcel; Schrickel, Jan W.; Nickenig, Georg; Hammerstingl, Christoph; Sedaghat, Alexander

doi:10.1007/s00392-020-01651-8

Cited by 16 publications

(31 citation statements)

References 34 publications

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“…Additionally, the thrombus resolution time was 20 and 30 weeks in the non‐VCM and VCM groups, respectively. This was much longer than the resolution times reported in previous studies (11 weeks in the NOAC group and 17 weeks in the VKA group) 4 . In the current study, Zhang et al 5 used multiple modalities including TEE, cardiac computed tomographic angiography, cardiovascular magnetic resonance imaging, or transthoracic echocardiography instead of using a unique tool, to detect the presence or resolution of atrial thrombus, which may also render the comparisons across the different subgroups of patients difficult.…”

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confidence: 83%

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confidence: 90%

“…This was much longer than the resolution times reported in previous studies (11 weeks in the NOAC group and 17 weeks in the VKA group). 4 In the current study, Zhang et al 5 used multiple modalities including TEE, cardiac computed tomographic angiography, cardiovascular magnetic resonance imaging, or transthoracic echocardiography instead of using a unique tool, to detect the presence or resolution of atrial thrombus, which may also render the comparisons across the different subgroups of patients difficult. Nevertheless, the results suggest that the interaction of VCM and atrial remodeling plays an important role in the formation of the thrombus.…”

Section: Editorial To "The Differences Of Atrial Thrombus Locations Amentioning

confidence: 99%

“…Dominik et al examined the clinical and echocardiographic determinants of LAA thrombus resolution in 78 patients and found no differences in left ventricular ejection fraction (LVEF), LAA velocity, thrombus diameter, and LAdiameter between responders and nonresponders 4. There was also no difference between the use of VKA and NOACs in the proportion of thrombus resolution.…”

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confidence: 99%

“…There was also no difference between the use of VKA and NOACs in the proportion of thrombus resolution. Interestingly, in the NOACs group, the time taken to reach full resolution was shorter compared to VKA (81 ± 38 days vs 129 ± 46 days, P = .03) 4. Zhang et al retrospectively examined the locations of atrial thrombus and the determinants of thrombus resolution in response to anticoagulant therapy in 191 patients with AF and atrial thrombosis 5.…”

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confidence: 99%

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Editorial to “The differences of atrial thrombus locations and variable response to anticoagulation in non‐valvular atrial fibrillation with ventricular cardiomyopathy”

Chung

Chen

et al. 2020

Journal of Arrhythmia

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confidence: 83%

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confidence: 90%

Section: Editorial To "The Differences Of Atrial Thrombus Locations Amentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Editorial to “The differences of atrial thrombus locations and variable response to anticoagulation in non‐valvular atrial fibrillation with ventricular cardiomyopathy”

Chung

Chen

et al. 2020

Journal of Arrhythmia

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Electrical cardioversion of atrial arrhythmias with cardiac amyloidosis in the era of direct oral anticogulants

Touboul¹,

Algalarrondo

Oghina³

et al. 2022

ESC Heart Failure

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Aims Atrial fibrillation (AF)/atrial flutter is common during cardiac amyloidosis (CA). Electrical cardioversion (EC) is a strategy to restore sinus rhythm (SR). However, left atrial thrombus (LAT) represents a contraindication for EC. CA patients with AF/atrial flutter have a high prevalence of LAT. We aimed to evaluate EC characteristics, LAT prevalence and risk factors, and AF/atrial flutter outcome in CA patients undergoing EC, predominantly treated with direct oral anticoagulants (DOACs). Methods and resultsAll patients with CA and AF/atrial flutter referred for the first time to our national referral centre of amyloidosis for EC from June 2017 to February 2021 were included in this study. In total, 66 patients (median age 74.5 [70;80.75] years, 67% male) were included with anticoagulation consisted of DOAC in 74% of cases. All patients underwent cardiac imaging before EC to rule out LAT. EC was cancelled due to LAT in 14% of cases. Complete thrombus resolution was observed in only 17% of cases. The two independent parameters associated with LAT were creatinine [hazard ratio (HR) = 1.01; confidence interval (CI) = 1.00-1.03, P = 0.036] and the use of antiplatelet agents (HR = 13.47; CI = 1.85-98.02). EC acute success rate was 88%, and we observed no complication after EC. With 64% of patients under amiodarone, AF/atrial flutter recurrence rate following EC was 51% after a mean follow-up of 30 ± 27 months. Conclusions Left atrial thrombus was observed in 14% of CA patients listed for EC and mainly treated with DOAC. The acute EC success rate was high with no complication. The long-term EC success rate was acceptable (49%).

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Anti-thrombotic strategies in patients with atrial fibrillation undergoing PCI

2020

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Triple anti-thrombotic therapy combining oral anticoagulation and dual anti-platelet therapy following percutaneous coronary intervention in patients with atrial fibrillation was considered as standard and recommended by guidelines. While bleeding risk is considerable with that approach, data for efficacy are scare. Several trials assessed the possibility of reducing antithrombotic treatment by mainly shortening the exposure to acetylsalicylic acid. Dropping one of the anti-platelet components might increase the risk of stent thrombosis, myocardial infarction or stroke. Despite that fear, the recent trials' primary endpoint was major and/or clinically-relevant non-major bleeding. We review data on major bleedings, intracranial bleedings and major adverse cardiovascular events from the published reports. We demonstrate that Non-Vitamin K oral anticoagulant (NOAC)-based strategies compared to VKA-based triple therapies significantly reduce the risk for TIMI-major bleedings by 39% and for intracranial bleedings by 66%, while they did not increase the risk for overall ischemic or embolic events. However, recent meta-analyses indicate an increased risk for stent thrombosis with less intense anti-thrombotic therapy. While the overall incidence rate for stent thrombosis is rather low, relative increases by about 30-60% are reported, but they did not translate into adverse clinical net-benefit ratios. This review highlights that using certain NOAC regimens proven effective for stroke prevention in AF can reduce the rate of bleeding without increasing ischemic or embolic events. Furthermore, additive ASA in triple anti-thrombotic regimens should be limited to 1 month and individual weighing of ischemic versus bleeding risk during the first 30 days seems to be reasonable.

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Clinical outcomes and thrombus resolution in patients with solid left atrial appendage thrombi: results of a single-center real-world registry

Cited by 16 publications

References 34 publications

Editorial to “The differences of atrial thrombus locations and variable response to anticoagulation in non‐valvular atrial fibrillation with ventricular cardiomyopathy”

Editorial to “The differences of atrial thrombus locations and variable response to anticoagulation in non‐valvular atrial fibrillation with ventricular cardiomyopathy”

Electrical cardioversion of atrial arrhythmias with cardiac amyloidosis in the era of direct oral anticogulants

Anti-thrombotic strategies in patients with atrial fibrillation undergoing PCI

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