RIVAroxaban TWICE daily for lysis of thrombus in the left atrial appendage in patients with non-valvular atrial fibrillation: the RIVA-TWICE study

Piotrowski, Roman; Zaborska, Beata; Pilichowska-Paszkiet, Ewa; Sikora-Frąc, Małgorzata; Kułakowski, Piotr

doi:10.5114/aoms.2019.86616

Cited by 12 publications

(12 citation statements)

References 25 publications

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“…Little is known, however, about what kind of action should be undertaken if patient is diagnosed with thrombus in LAA despite apparently correct chronic OAC treatment [23]. Published data is scarce and limited mainly to small case series or case reports [9,[24][25][26]. In a survey conducted by the European Heart Rhythm Association (EHRA), responders reported over a dozen of potential options when dealing with OAC-resistant thrombus [8].…”

Section: Introductionmentioning

confidence: 99%

The Comparative Effectiveness and Safety of Different Anticoagulation Strategies for Treatment of Left Atrial Appendage Thrombus in the Setting of Chronic Anticoagulation for Atrial Fibrillation or Flutter

Kołakowski

Farkowski

Pytkowski

et al. 2021

Cardiovasc Drugs Ther

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Purpose To compare effectiveness of different treatments for atrial fibrillation (AF) patients who were scheduled for cardioversion (CV) or ablation (CA) presenting with left atrium appendage (LAA) thrombus despite chronic oral anticoagulation therapy (OAC). Methods This was a retrospective cohort study. We analyzed 2014–2019 medical records of patients scheduled for CV or CA of AF who were diagnosed with LAA thrombus despite optimal OAC and had a follow-up transesophageal echocardiogram (TOE). Changes in treatment were divided into the following groups: switch to a drug with different mechanism of action, switch to a drug with similar mechanism of action, initiation of combination therapy, or deliberate no change in treatment. Patients with contraindications to non-vitamin K antagonists were excluded from the analysis. Results We analyzed data of 129 patients comprising 181 cycles of treatment. The overall effectiveness of LAA thrombus dissolution was 51.9% regardless of the number of cycles and 42.6% for the first cycle of treatment. Any change of treatment was more effective than deliberate no change—OR 2.97 [95% CI: 1.07–8.25], P = 0.031, but no particular strategy seemed to be more effective than the other. Left atrium area (OR 0.908 [95% CI: 0.842–0.979]) and number of treatment cycles (OR 0.457 [95% CI: 0.239–0.872]) were both adversely related to thrombus resolution. There was one ischemic and three bleeding adverse events during the treatment. Conclusion LAA thrombus resolution in patients already on OAC may require a change of previous OAC treatment but the overall effectiveness of dissolution seems to be about 50%.

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Section: Introductionmentioning

confidence: 99%

The Comparative Effectiveness and Safety of Different Anticoagulation Strategies for Treatment of Left Atrial Appendage Thrombus in the Setting of Chronic Anticoagulation for Atrial Fibrillation or Flutter

Kołakowski

Farkowski

Pytkowski

et al. 2021

Cardiovasc Drugs Ther

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“…The aim of the CLOT-AF registry was to provide retrospective thrombus-related patient outcome data after standard-of-care anticoagulant therapy in patients with AFL or nonvalvular AF who had documented LAT/LAAT on TEE [36]. In contrast, the RIVA-TWICE study showed that the increased dose of rivaroxaban (15 mg twice daily in patients with AF and LAAT despite rivaroxaban 20 mg once a day therapy) was associated with LAAT resolution in 46.7% of participants [37]. Unfortunately, the RE-LATED_AFNET7 trial on the efficacy of dabigatran in LAA thrombus resolution has not been published due to its premature termination [38].…”

Section: Discussionmentioning

confidence: 99%

Left atrial appendage thrombus in patients referred to electrical cardioversion for atrial fibrillation: a prospective single-center study

Turek¹,

Sadowski²,

Janion−Sadowska³

et al. 2022

Polish Archives of Internal Medicine

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What's new?Patients with atrial fibrillation (AF) are at risk of stroke. However, the risk stratification remains complicated. It is currently unknown whether left atrial appendage thrombus (LAAT) in patients with AF on chronic anticoagulation contributes significantly to that risk. In this study, during a 12-month follow-up period, we investigated mortality, stroke, and systemic thromboembolic events in patients with AF on oral anticoagulation and transesophageal echocardiography confirmed LAAT. No stroke or thromboembolic events were recorded, and deaths (1.01%) in the LAAT group were not considered LAAT-related. We speculate that the presence of LAAT might not serve as a real indicator of inadequacy of oral anticoagulation in patients with AF.

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“…AF seems to be an underestimated factor. Patients with AF have more comorbidities and have a higher risk of complications [4,18,19].…”

Section: Discussionmentioning

confidence: 99%

Comparison of clinical characteristics, treatment, in-hospital and 12-month outcomes in patients after myocardial infarction with ejection fraction < 40% with or without atrial fibrillation

et al. 2020

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IntroductionThe study aimed to compare the characteristics, treatment, and 12-month outcomes of patients after myocardial infarction (MI) and with left ventricular ejection fraction (LVEF) < 40%, with or without atrial fibrillation (AF).Material and methodsThe analysis involved 10,222 surviving patients who were enrolled in the ongoing, prospective Polish Registry of Acute Coronary Syndromes (PL-ACS). The major adverse cardiac events (MACE) involved death, non-fatal MI, rehospitalization due to heart failure (HF), and stroke within 12 months after MI.ResultsPatients with AF were older (73.7 [13.1] vs. 68.3 [16.4], p < 0.001) and had a greater prevalence of previous MI (37.3% vs. 32.4%, p = 0.0007), percutaneous coronary intervention (PCI) (27.5% vs. 23.6%, p = 0.002), and HF hospitalization (34.6% vs. 19.7%, p < 0.001). In patients with AF, coronary angiography (87.3% vs. 92.5%, p < 0.001) and PCI (76.8% vs. 82.7%, p < 0.001) were performed less frequently. Patients with AF had a higher rate of all-cause mortality (26.8% vs. 17.4%, p < 0.001), HF hospitalization (35.0% vs. 25.3%, p < 0.001), stroke (5.5% vs. 2.1%, p < 0.001) and MACE (56.2% vs. 42.8%, p < 0.001). In the multivariate analysis, AF was revealed to be associated with a higher all-cause mortality (odds ratio 1.20, 95% confidence interval 1.03–1.40, p = 0.018).ConclusionsPatients after MI with LVEF < 40% and with AF, compared to those without AF, had worse clinical characteristics, were less frequently subjected to coronary angiography and PCI during hospitalization, and had significantly less favorable 12-month outcomes.

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RIVAroxaban TWICE daily for lysis of thrombus in the left atrial appendage in patients with non-valvular atrial fibrillation: the RIVA-TWICE study

Cited by 12 publications

References 25 publications

The Comparative Effectiveness and Safety of Different Anticoagulation Strategies for Treatment of Left Atrial Appendage Thrombus in the Setting of Chronic Anticoagulation for Atrial Fibrillation or Flutter

The Comparative Effectiveness and Safety of Different Anticoagulation Strategies for Treatment of Left Atrial Appendage Thrombus in the Setting of Chronic Anticoagulation for Atrial Fibrillation or Flutter

Left atrial appendage thrombus in patients referred to electrical cardioversion for atrial fibrillation: a prospective single-center study

Comparison of clinical characteristics, treatment, in-hospital and 12-month outcomes in patients after myocardial infarction with ejection fraction < 40% with or without atrial fibrillation

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