Short- and long-term outcome of patients with spontaneous echo contrast or thrombus in the left atrial appendage in the era of the direct acting anticoagulants,Clinical Research in Cardiology

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Short- and long-term outcome of patients with spontaneous echo contrast or thrombus in the left atrial appendage in the era of the direct acting anticoagulants
Clinical Research in Cardiology ( IF 3.8 ) Pub Date : 2021-08-26 , DOI: 10.1007/s00392-021-01926-8
Julian Felix Backhaus ₁ , Andreas Pflaumbaum ₁ , Fabienne Kreimer ₁ , Andreas Mügge ₁ , Michael Gotzmann ₁ , Christos Krogias ₂ , Ralf Gold ₂

Affiliation

Background

Thrombi and spontaneous echo contrast (SEC) in the left atrial appendage (LAA) are associated with thromboembolic events and poor prognosis. There are very few data on long-term outcome, especially with the use of direct acting anticoagulants (DOAC).

Methods

In this retrospective study, all transoesophageal echocardiographies performed at a tertiary care university hospital from 2015 to 2020 were analyzed. All patients with thrombus or SEC in the LAA were included. Medical history, laboratory, echocardiographic parameters and medication at discharge were documented. The primary endpoint of the study was a composite endpoint (all-cause mortality, non-fatal stroke or transient ischaemic attack [TIA], non-fatal systemic embolization, non-fatal major bleeding and non-fatal myocardial infarction).

Results

Of a total of 4062 transoesophageal echocardiographies, thrombi were detected in 51 patients (1.2%) and SEC in 251 patients (6.2%). These patients formed the final study cohort (n = 302). During a mean follow-up period of 956 ± 663 days, 87 patients (29%) suffered the primary point. The following baseline characteristics predicted the primary endpoint: age, haemoglobin, a previous coronary artery bypass grafting, dialysis and choice of anticoagulation. Prescription of apixaban at discharge was associated with lower rate of adverse events (hazard ratio 0.564, confidence interval 0.331–0.960; p = 0.035) while prescription of dabigatran was associated with higher rate of adverse events (hazard ratio 3.091, confidence interval 1.506–6.347; p = 0.002).

Conclusion

Even in the DOAC era, the occurrence of thrombus or SEC in the LAA is associated with a high rate of MACCE. Our study suggests that the choice of DOAC therapy may have an impact on long-term survival.

Graphic abstract

中文翻译：

直接作用抗凝剂时代左心耳自发性回声造影或血栓患者的短期和长期预后

背景

左心耳 (LAA) 中的血栓和自发回声对比 (SEC) 与血栓栓塞事件和不良预后相关。关于长期结果的数据很少，尤其是在使用直接作用抗凝剂 (DOAC) 的情况下。

方法

在这项回顾性研究中，分析了 2015 年至 2020 年在三级医疗大学医院进行的所有经食管超声心动图检查。包括所有左心耳内有血栓或 SEC 的患者。记录病史、实验室、超声心动图参数和出院时用药。研究的主要终点是复合终点（全因死亡率、非致命性中风或短暂性脑缺血发作 [TIA]、非致命性全身栓塞、非致命性大出血和非致命性心肌梗死）。

结果

在总共 4062 次经食管超声心动图检查中，51 名患者 (1.2%) 检测到血栓，251 名患者 (6.2%) 检测到 SEC。这些患者形成了最终的研究队列 ( n = 302)。在 956 ± 663 天的平均随访期间，87 名患者 (29%) 遭受了主要点。以下基线特征预测了主要终点：年龄、血红蛋白、先前的冠状动脉旁路移植术、透析和抗凝剂的选择。出院时服用阿哌沙班与较低的不良事件发生率相关（风险比 0.564，置信区间 0.331–0.960；p = 0.035），而处方达比加群与较高的不良事件发生率相关（风险比 3.091，置信区间 1.506–6.347 ; p = 0.002)。