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%.

中文翻译：

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不同抗凝策略治疗左心耳血栓在心房颤动或扑动慢性抗凝治疗中的比较有效性和安全性

目的

比较不同治疗方法对计划进行复律 (CV) 或消融 (CA) 的心房颤动 (AF) 患者的有效性，这些患者尽管接受了长期口服抗凝治疗 (OAC)，但仍出现左心耳 (LAA) 血栓。

方法

这是一项回顾性队列研究。我们分析了 2014-2019 年计划接受 CV 或 CA AF 患者的病历，这些患者尽管采用最佳 OAC 并进行了经食管超声心动图 (TOE) 随访，但仍被诊断为 LAA 血栓。治疗变化分为以下几组：改用具有不同作用机制的药物、改用具有相似作用机制的药物、开始联合治疗或故意不改变治疗。对非维生素 K 拮抗剂有禁忌症的患者被排除在分析之外。

结果

我们分析了 129 名患者的数据，包括 181 个治疗周期。无论周期数如何，左心耳血栓溶解的总体有效性为 51.9%，第一个治疗周期为 42.6%。任何治疗的改变都比故意不改变更有效——OR 2.97 [95% CI：1.07–8.25]，P  = 0.031，但似乎没有特定策略比另一种更有效。左心房面积 (OR 0.908 [95% CI: 0.842–0.979]) 和治疗周期数 (OR 0.457 [95% CI: 0.239–0.872]) 均与血栓溶解呈负相关。治疗期间发生 1 例缺血性不良事件和 3 例出血性不良事件。

结论

已经接受 OAC 治疗的患者 LAA 血栓消退可能需要改变之前的 OAC 治疗，但溶解的总体有效性似乎约为 50%。