Prevalence and predictors of left atrial thrombosis in atrial fibrillation patients treated with non-vitamin K antagonist oral anticoagulants,Acta Cardiologica

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Prevalence and predictors of left atrial thrombosis in atrial fibrillation patients treated with non-vitamin K antagonist oral anticoagulants
Acta Cardiologica ( IF 1.6 ) Pub Date : 2021-11-25 , DOI: 10.1080/00015385.2021.2005307
Filippo Angelini ₁ , Pier Paolo Bocchino ₁ , Mattia Peyracchia ₁ , Andrea Saglietto ₁ , Massimo Magnano ₁ , Nicolò Patanè ₁ , Fabrizio D'Ascenzo ₁ , Carla Giustetto ₁ , Matteo Anselmino ₁ , Fiorenzo Gaita ₁ , Elisabetta Toso ₁

Affiliation

Abstract

Background

Few data are available regarding the prevalence of left atrium (LA) thrombi in atrial fibrillation (AF) patients treated with non-vitamin K antagonist oral anticoagulants (NOACs). Methods: We evaluated the prevalence and predictors of LA/LA appendage (LAA) thrombi in non-valvular AF patients treated with NOACs referring to a single centre for a scheduled electrical cardioversion (ECV) or catheter ablation (CA). Transesophageal echocardiography (TEE) was performed within 12 h prior to the index procedure.

Results

A total of 352 consecutive patients with non-valvular AF treated with NOACs were included in this analysis (ECV group n = 176 and CA group n = 176) between 2013 and 2018. 85 patients (24.2%) were on dabigatran, 150 (42.7%) on rivaroxaban, 104 (29.6%) on apixaban and 13 (3.7%) on edoxaban. A LA/LAA thrombus was detected by TEE in 27 (7.7%) patients, 18 in the ECV group and nine in the ablation group; 18 (5.1%) patients presented dense LA/LAA spontaneous echo contrast (SEC). Predictors of LA/LAA thrombi were a CHA₂DS₂-VASc score > 3 (OR 4.54, 95% CI 1.50 − 13.70, p value = .007) and obesity (OR 6.01, 95% CI 1.95 − 18.50, p value = .001).

Conclusions

Among real-world patients with non-valvular AF treated with NOACs, we found a high incidence of LA/LAA thrombi compared to previous reports. The main predictors of LA/LAA thrombosis were a CHA₂DS₂-VASc score > 3 and obesity.

中文翻译：

接受非维生素 K 拮抗剂口服抗凝剂治疗的心房颤动患者左心房血栓形成的患病率和预测因素

摘要

背景

关于接受非维生素 K 拮抗剂口服抗凝剂 (NOAC) 治疗的心房颤动 (AF) 患者左心房 (LA) 血栓患病率的数据很少。方法：我们评估了接受 NOAC 治疗的非瓣膜性 AF 患者 LA/LA 附件 (LAA) 血栓的患病率和预测因子，指的是单个中心的预定电复律 (ECV) 或导管消融 (CA)。经食管超声心动图 (TEE) 在索引程序前 12 小时内进行。

结果

2013 年至 2018 年间，共有 352 名接受 NOAC 治疗的连续非瓣膜性房颤患者被纳入该分析（ECV 组n = 176，CA 组n = 176）。85 名患者 (24.2%) 使用达比加群，150 名 (42.7) %) 服用利伐沙班，104 人 (29.6%) 服用阿哌沙班，13 人 (3.7%) 服用依度沙班。27 例 (7.7%) 患者通过 TEE 检测到 LA/LAA 血栓，ECV 组 18 例，消融组 9 例；18 名 (5.1%) 患者呈现密集的 LA/LAA 自发回声对比 (SEC)。LA/LAA 血栓的预测因素是 CHA ₂ DS ₂ -VASc 评分 > 3（OR 4.54，95% CI 1.50 − 13.70，p值 = .007）和肥胖（OR 6.01，95% CI 1.95 − 18.50，p值 = .001）。