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. 2023 Feb;37(1):159-168.
doi: 10.1007/s10557-021-07278-9. Epub 2021 Oct 20.

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

Karol Kołakowski  1 , Michał M Farkowski  2 , Mariusz Pytkowski  1 , Piotr Gardziejczyk  1 , Ilona Kowalik  3 , Rafał Dąbrowski  3 , Bohdan Firek  3 , Krzysztof Jaworski  3 , Anna Klisiewicz  4 , Aleksander Maciąg  1
Affiliations

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

Karol Kołakowski et al. Cardiovasc Drugs Ther. 2023 Feb.

Erratum in

Abstract

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%.

Keywords: Anticoagulation; Atrial fibrillation; Dissolution; Left atrial appendage; Resolution; Thrombus.

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Conflict of interest statement

MMF received lecturer fees from Pfizer and Boehringer Ingelheim, and RD received lecturer fees from Bayer and Boehringer Ingelheim. All the other authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Thrombus grade 3 occupying almost all volume of left atrium appendage
Fig. 2
Fig. 2
Thrombus grade 2 occupying nearly half of left atrium appendage
Fig. 3
Fig. 3
Unequivocal “sludge” in left atrium appendage
Fig. 4
Fig. 4
Flow diagram of patients’ selection for the analysis. AF, atrial fibrillation; AFL, with atrial flutter; OAC, oral anticoagulant; NOAC, novel oral anticoagulant; TOE, transesophageal echocardiography
See this image and copyright information in PMC

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