Efficacy and safety of rivaroxaban on the resolution of left atrial/left atrial appendage thrombus in nonvalvular atrial fibrillation patients

Ke, Honghong; Lv, Xiangwei; Zhang, Enhao; Wei, Zhe; Li, Jin-Yi

doi:10.1007/s11239-019-01876-z

Cited by 21 publications

(30 citation statements)

References 22 publications

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“…Moreover, the anticoagulation duration in the current study was longer than that in the X‐TRA study. Ke et al 13 conducted a randomized controlled trial of rivaroxaban 20 mg qd vs warfarin for LA thrombus detected by TEE in 80 subjects scheduled to undergo catheter ablation for nonvalvular AF. Repeat TEE was performed at 12 weeks, with complete resolution observed in 32 (80%) subjects in the rivaroxaban group 13 .…”

Section: Discussionmentioning

confidence: 99%

“…Ke et al 13 conducted a randomized controlled trial of rivaroxaban 20 mg qd vs warfarin for LA thrombus detected by TEE in 80 subjects scheduled to undergo catheter ablation for nonvalvular AF. Repeat TEE was performed at 12 weeks, with complete resolution observed in 32 (80%) subjects in the rivaroxaban group 13 . Fleddermann et al 14 reported a retrospective cohort study in 16 patients with AF who were treated with NOACs for LAA thrombus.…”

Section: Discussionmentioning

confidence: 99%

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

Lin

Quan

Bao

et al. 2020

Cardiovasc electrophysiol

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

Lin

Quan

Bao

et al. 2020

Cardiovasc electrophysiol

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“…Nevertheless, there is uncertainty regarding the application of these results for the management of LA thrombus. To the best of our knowledge, there have been only five publications on NOACs to date where all or the majority of subjects with AF or flutter were OAC naïve at the time of initial diagnosis of LA thrombus . Only three had warfarin comparison groups …”

Section: Discussionmentioning

confidence: 99%

“…Ke et al conducted a randomized controlled trial of rivaroxaban 20 mg qd versus warfarin for LA thrombus detected on TEE in 80 subjects who were scheduled for catheter ablation for nonvalvular AF at The First Affiliated Hospital of Guangxi Medical University . All subjects were free of OAC for one month prior to LA thrombus diagnosis and 80% were confined to the LA appendage.…”

Section: Discussionmentioning

confidence: 99%

“…To the best of our knowledge, there have been only five publications on NOACs to date where all or the majority of subjects with AF or flutter were OAC naïve at the time of initial diagnosis of LA thrombus. [19][20][21][22][23] Only three had warfarin comparison groups. 19,20,23 Hao Ultimately, multicenter randomized controlled trials to compare individual NOACs to warfarin or other NOACs should be performed.…”

Section: Discussionmentioning

confidence: 99%

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Non‐vitamin K oral anticoagulants versus warfarin for left atrial appendage thrombus resolution in nonvalvular atrial fibrillation or flutter

Hussain

Katz

Genuardi

et al. 2019

Pacing Clinical Electrophis

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Background Non‐vitamin K oral anticoagulants (NOACs) have emerged as alternatives to vitamin K antagonists in select situations. For left atrial (LA) appendage thrombus in nonvalvular atrial fibrillation (AF) or flutter, guidelines recommend oral anticoagulation (OAC) for at least 3 weeks prior to reassessment. Data comparing NOACs to warfarin in this scenario are scarce. Methods A retrospective study identified subjects with nonvalvular AF or flutter who were: a) noted to have LA thrombus detected on transesophageal echocardiography (TEE), b) previously not receiving long‐term OAC; and c) evaluated for resolution of LA thrombus by follow‐up TEE between 3 weeks to less than 1 year of the initial TEE. Results The study included 45 subjects with mean age 63.2 years, 69% male, 78% white race/ethnicity, 42% paroxysmal, and mean CHA2DS2‐VASc score 3.4 ± 1.7. All LA thrombi were confined to the appendage. OAC received included apixaban (3), dabigatran (13), rivaroxaban (6), and warfarin (23), The median follow‐up time to repeat TEE was 67 (interquartile range, 49‐96) days. LA appendage thrombus resolution rates were 76% for the entire cohort, 77% for NOACs, and 74% for warfarin. In univariable logistic regression analysis, LA appendage thrombus resolution was similar for NOACs when compared to warfarin (odds ratio, 1.20; 95% confidence interval, 0.31‐4.69; P = .79). Conclusions In patients nonvalvular AF or flutter who were OAC naïve at the time of diagnosis with LA appendage thrombus, complete resolution was similar between NOACs and warfarin.

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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

et al. 2020

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Efficacy and safety of rivaroxaban on the resolution of left atrial/left atrial appendage thrombus in nonvalvular atrial fibrillation patients

Cited by 21 publications

References 22 publications

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

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

Non‐vitamin K oral anticoagulants versus warfarin for left atrial appendage thrombus resolution in nonvalvular atrial fibrillation or flutter

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

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