Thromben im linken Herzohr bei Mitralvitien trotz adäquater Antikoagulation: Vorteile der transösophagealen Echokardiographie

W, Aschenberg; Siglow, V.; Kremer, P.; Schlüter, Michael; Bleifeld, W.

doi:10.1055/s-2008-1068117

Cited by 6 publications

(1 citation statement)

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“…During the past thirty years, TOE has become a valuable tool for diagnosis of thrombus within the appendage by allowing semi-invasive, highly accurate imaging of the LAA 139). It is, therefore, an essential part of the guidelines for management of AF,121) and the modality of choice for detecting LA or LAA thrombi with a sensitivity and specificity of approximately 95% to 100% 127).…”

Section: Cardiac Imaging For Thrombus Detectionmentioning

confidence: 99%

Cardioembolic Stroke in Atrial Fibrillation-Rationale for Preventive Closure of the Left Atrial Appendage

Leithäuser

Park

2009

Korean Circ J

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Atrial fibrillation is the most common cardiac arrhythmias, and a major cause of morbidity and mortality due to cardioembolic stroke. The left atrial appendage is the major site of thrombus formation in non-valvular atrial fibrillation. Loss of atrial systole in atrial fibrillation and increased relative risk of associated stroke point strongly toward a role for stasis of blood in left atrial thrombosis, although thrombus formation is multifactorial, and much more than blood flow irregularities are implicated. Oral anticoagulation with vitamin-K-antagonists is currently the most effective prophylaxis for stroke in atrial fibrillation. Unfortunately, this treatment is often contraindicated, particularly in the elderly, in whom risk of stroke is high. Moreover, given the risk of major bleeding, there is reason to be skeptical of the net benefit when warfarin is used in those patients. This work reviews the pathophysiology of cardioembolic stroke and critically spotlights the current status of preventive anticoagulation therapy. Various techniques to exclude the left atrial appendage from circulation were discussed as a considerable alternative for stroke prophylaxis.

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Section: Cardiac Imaging For Thrombus Detectionmentioning

confidence: 99%

Cardioembolic Stroke in Atrial Fibrillation-Rationale for Preventive Closure of the Left Atrial Appendage

Leithäuser

Park

2009

Korean Circ J

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Left atrial thrombi despite anticoagulant and antiplatelet therapy

Zotz¹,

U²,

Genth³

et al. 1994

Clinical Cardiology

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To investigate risk factors for embolization in patients with echocardiographically detected left atrial thrombi and to evaluate thrombus development, we examined 29 patients with transesophageal and transthoracic echocardiography at two points during a follow-up of 18 months. We compared patients with a history of possible arterial embolization (n = 13) with those without (n = 16) in regard to age, gender, left atrial dilatation, localization of the thrombus in the left atrial cavity, spontaneous echo contrast, and atrial fibrillation. Eight patients were treated with aspirin, 20 with phenprocoumon. Only left atrial spontaneous contrast was associated with thromboembolism (10/15 patients with spontaneous contrast experienced arterial embolism; p = 0.038). In six patients arterial embolism occurred after thrombus detection (14% per patient per year). Four of these patients were treated with phenprocoumon, two with aspirin. At reexamination, one thrombus was detected in the patient without anticoagulant treatment and one thrombus was detected in the 8 patients treated with aspirin (13%), compared with ten thrombi detected in the 20 patients (50%) treated with phenprocoumon (p = NS). In 17 patients no thrombus was seen at reexamination. Since only 2 patients had undergone thrombectomy and 3 experienced arterial embolism during follow-up, thrombi disappeared under medical therapy in 12 patients. Patients with left atrial thrombi have a high risk of arterial embolization despite proper anticoagulative or antiplatelet treatment. Embolization occurs significantly more often if spontaneous echo contrast can be visualized. Left atrial thrombi can be reduced in size by the administration of antiplatelet and anticoagulative agents.(ABSTRACT TRUNCATED AT 250 WORDS)

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Literatur

Hammentgen

1991

Transösophageale Echokardiographie Monoplan/Biplan

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Thromben im linken Herzohr bei Mitralvitien trotz adäquater Antikoagulation: Vorteile der transösophagealen Echokardiographie

Cited by 6 publications

References 0 publications

Cardioembolic Stroke in Atrial Fibrillation-Rationale for Preventive Closure of the Left Atrial Appendage

Cardioembolic Stroke in Atrial Fibrillation-Rationale for Preventive Closure of the Left Atrial Appendage

Left atrial thrombi despite anticoagulant and antiplatelet therapy

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