Rapid left atrial appendage thrombus formation before suture ligation with LARIAT

Bartuś, Krzysztof; Myć, Jacek; Bartuś, Magdalena; Lee, Randall J.; Litwinowicz, Radosław; Dziewierz, Artur; Kapelak, Bogusław

doi:10.5114/aic.2018.79876

Cited by 6 publications

(8 citation statements)

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“…This includes (1) blood stasis; (2) abnormalities of the vessel wall; and (3) regional and systemic inflammation resulting in a prothrombotic and hypercoagulable state [30]. The most common site of intracardiac thrombus formation in patients with AF is the LA, specifically the LAA, the source of embolic thrombi in more than 90% [31] which in some cases may be quite rapid [32].…”

Section: Discussionmentioning

confidence: 99%

“…In patients who cannot tolerate long-term oral anticoagulation, mechanical exclusion of a highly prothrombotic LAA has proven to be effective in minimizing the risk of STE and systemic complications [18,19,[39][40][41][42][43][44][45]. Even though mechanical occlusion reduces the risk of STE to a greater degree, it does not completely eliminate it [40,46].…”

Section: Discussionmentioning

confidence: 99%

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Coagulation factors and fibrinolytic activity in the left atrial appendage and other heart chambers in patients with atrial fibrillation: is there a local intracardiac prothrombotic state? (HEART-CLOT study)

Bartuś

Litwinowicz

Natorska

et al. 2020

International Journal of Cardiology

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Atrial fibrillation (AF), a risk factor for stroke and systemic thromboembolism, is associated with unfavorable fibrin clot properties and increased thrombus formation in peripheral blood. The left atrial appendage (LAA) is known to be the primary site of thrombus formation. Aim: We investigated the relative differences in plasma fibrin clot features including plasma fibrin clot permeability (K s ) and clot lysis time (CLT) between the right atrium (RA), right ventricle (RV), left atrium (LA), left ventricle (LV), LAA, and peripheral blood. Methods: Sixteen patients with nonvalvular AF who stopped oral anticoagulant therapy at least 2 days before a LARIAT procedure participated in a single-center prospective study. We measured fibrinogen and plasminogen levels along with K s , CLT, and endogenous thrombin potential (ETP) during the LARIAT procedure in blood obtained from the right femoral vein, RA, RV, LA, LV and LAA. Results: LAA clot porosity was reduced by 16.2% compared to peripheral blood (p = 0.026), also after adjustment for fibrinogen levels (p = 0.038). K s was similar for the RA, RV, LA, LV, and LAA (all p N 0.05). We found 14.7% prolonged CLT for clots prepared from blood samples obtained from the LAA compared to those prepared from peripheral blood, but no differences between the RA, RV, LA and LV (all p N 0.05) were found. There were no significant differences in other parameters, including ETP, between heart chambers. Conclusions: Patients with AF are characterised by a local prothrombotic state as reflected by formation of compact fibrin clots in the LAA compared to peripheral blood, which may contribute to LAA thrombus formation and device-related thrombi.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Coagulation factors and fibrinolytic activity in the left atrial appendage and other heart chambers in patients with atrial fibrillation: is there a local intracardiac prothrombotic state? (HEART-CLOT study)

Bartuś

Litwinowicz

Natorska

et al. 2020

International Journal of Cardiology

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“…Device related thrombus may occur during the procedure (44, 49) and at every stage of follow up after the procedure (33). In the analysis of device arms of 4 prospective FDA trials (PROTECT-AF, PREVAIL, CAP and.…”

Section: Left Atrial Appendage Closure (Laac)mentioning

confidence: 99%

Antithrombotic/Antiplatelet Treatment in Transcatheter Structural Cardiac Interventions—PFO/ASD/LAA Occluder and Interatrial Shunt Devices

Olasińska-Wiśniewska

Grygier

2019

Front. Cardiovasc. Med.

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Transcatheter interventions enable safe and efficient treatment of various structural heart diseases. However, therapy does not finished with the end of the procedure. Device thrombosis is a possible serious complication. Therefore, careful patient management should include optimal antiplatelet or antithrombotic medication to enhance safe and complete endothelial coverage of the implanted device. In case of thrombus formation careful diagnostic evaluation and prompt treatment is crucial. This paper provides an update to current knowledge and understanding of prevention and management of device related thrombosis.

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“…As the left atrial appendage is the source of thrombus in 90% of patients with NVAF [5,6] following LAAO, anticoagulation therapy may not be required. Currently, recommendations for postprocedure anticoagulation depend on the system used, varying from no treatment to life-long combination therapy with OAC and antiplatelet agents [1,2,7,8].…”

Section: Introductionmentioning

confidence: 99%

Long-term effect of anticoagulation following left atrial appendage occlusion with the LARIAT device in patients with nonvalvular atrial fibrillation: impact on thromboembolism, bleeding and mortality. Real life data

Litwinowicz¹,

Filip²,

Sobczyk³

et al. 2020

pwki

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Introduction: Indications for left atrial appendage occlusion (LAAO) are varied and patients require individual management strategies. However, currently no guidelines exist for postprocedure oral anticoagulation (OAC) after an LAAO procedure.Aim: To evaluate the effect of OAC on thromboembolism, bleeding and mortality following the LAAO procedure for patients with AF.Material and methods: One hundred and thirty-nine consecutive patients with nonvalvular atrial fibrillation (NVAF) who underwent LAAO with the LARIAT device were followed for at least 40 months. Decisions about OAC and its modifications were individualized based on clinical presentation, patient and physician preferences.Results: Following LAAO, 52 (41%) patients did not receive OAC (No-OAC group) and 75 (59%) patients received OAC (OAC group), without any intergroup differences in CHADS 2 , CHA 2 DS 2 -VASc score or other thromboembolic risk factors. The median HAS-BLED score was higher in the OAC-group (median 3 (3-4) vs. 3 (2-4), p = 0.014). During a median follow-up time of 51 (43-57) vs. 55 (48-59) months in the No-OAC group and in the OAC group (p = 0.19) there were no significant differences between groups in ischemic stroke/TIA, 0 (0%) vs. 2 (2.7%), other thromboembolic events, 0 (0%) vs. 1 (1.3%), life-threatening, disabling or major events, 2 (3.7%) vs. 2 (2.7%), or annual mortality rate, 1.9% vs. 0.9%, respectively.Conclusions: There is no need for OAC after the LAAO procedure. Omitting OAC after an LAAO procedure in AF patients: (1) has similar stroke prevention rates as patients on OAC, (2) has similar bleeding prevention rates as patients on OAC, (3) has similar safety endpoints and long-term efficacy as patients on OAC.

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Rapid left atrial appendage thrombus formation before suture ligation with LARIAT

Cited by 6 publications

References 4 publications

Coagulation factors and fibrinolytic activity in the left atrial appendage and other heart chambers in patients with atrial fibrillation: is there a local intracardiac prothrombotic state? (HEART-CLOT study)

Coagulation factors and fibrinolytic activity in the left atrial appendage and other heart chambers in patients with atrial fibrillation: is there a local intracardiac prothrombotic state? (HEART-CLOT study)

Antithrombotic/Antiplatelet Treatment in Transcatheter Structural Cardiac Interventions—PFO/ASD/LAA Occluder and Interatrial Shunt Devices

Long-term effect of anticoagulation following left atrial appendage occlusion with the LARIAT device in patients with nonvalvular atrial fibrillation: impact on thromboembolism, bleeding and mortality. Real life data

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