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. 2022 Sep;64(3):773-781.
doi: 10.1007/s10840-022-01169-1. Epub 2022 Mar 11.

Left atrial thrombus and smoke resolution in patients with atrial fibrillation under chronic oral anticoagulation

Andrea Di Cori  1 , Valentina Barletta  2 , Laura Meola  2 , Matteo Parollo  2 , Lorenzo Mazzocchetti  2 , Marisa Carluccio  2 , Giulia Branchitta  2 , Tea Cellamaro  2 , Francesco Gentile  2 , Luca Segreti  2 , Stefano Viani  2 , Raffaele De Lucia  2 , Ezio Soldati  2 , Giulio Zucchelli  2 , Maria Grazia Bongiorni  2
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Left atrial thrombus and smoke resolution in patients with atrial fibrillation under chronic oral anticoagulation

Andrea Di Cori et al. J Interv Card Electrophysiol. 2022 Sep.

Abstract

Background: The study aimed to explore the resolution of left atrial and left atrial appendage (LAA) spontaneous echo-contrast or thrombus in patients with nonvalvular atrial fibrillation/flutter (AF/AFL) under chronic oral anticoagulation (OAC).

Methods: A single-center retrospective analysis of patients who underwent a transesophageal echocardiography (TOE) for an electrical cardioversion was conducted.

Results: Among 277 TOE performed, 73 cases (26%) of LAA echo-contrast or thrombus were detected, 53 patients with LAA/LA echo-contrast (19%) and 20 (7%) with a thrombus. All patients were under chronic anticoagulation with a VKA (65%) or with a NOAC (35%). The Echo-contrast Group maintained the same OAC strategy in 49 patients (93%). The Thrombus Group kept the same OAC strategy with a NOAC in 6 cases (30%) and changed the strategy in 14 patients (70%), titrating NOAC dose in 1 (5%) and the VKA dose in 4 (20%) and switching from NOAC to VKA in 5 (25%), from VKA to NOAC in 3 (15%), and from NOAC to NOAC in 1 (5%). Smoke resolution was observed in 4/40 cases (10%) of the smoke group and thrombus resolution in 8/15 (53%) of the thrombus group. Patients with thrombus resolution had a lower CHA2DS2-Vasc score (3.5 ± 2 vs 4 ± 1, p = 0.05), were more often under NOAC (37.5 vs 28%, p = 0.07), and had a longer anticoagulation time (7.5 vs 4 months, p = 0.08).

Conclusion (s): Changing OAC strategy is associated with thrombus resolution in more than 50% of chronically anticoagulated patients.

Keywords: Atrial fibrillation; Atrial thrombus; Oral anticoagulation; Transesophageal echocardiography.

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