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Observational Study
. 2023 Jan-Dec:29:10760296231168097.
doi: 10.1177/10760296231168097.

Characteristics, Thrombus Resolution, and Long-Term Outcomes in Patients with Nonvalvular Atrial Fibrillation and Atrial Thrombus

Shu Yang  1 , Yanjuan Zhang  1 , Ning Chen  1 , Jiaojiao Shi  1 , Weizhu Ju  1 , Hongwu Chen  1 , Gang Yang  1 , Zidun Wang  1 , Hailei Liu  1 , Xiaohong Jiang  1 , Chang Cui  1 , Minglong Chen  1 , Mingfang Li  1
Affiliations
Observational Study

Characteristics, Thrombus Resolution, and Long-Term Outcomes in Patients with Nonvalvular Atrial Fibrillation and Atrial Thrombus

Shu Yang et al. Clin Appl Thromb Hemost. 2023 Jan-Dec.

Abstract

To assess the prevalence and management of atrial thrombus in patients with nonvalvular atrial fibrillation (NVAF) and identify the risk factors of the nonresolution of atrial thrombus. This single-center retrospective observational study consecutively enrolled patients with NVAF and atrial thrombus detected using transesophageal echocardiography (TEE) or cardiac computed tomography angiography (CTA) from January 2012 to December 2020. Patients with prior left atrial appendage (LAA) intervention were excluded. The primary endpoint was the presence of atrial thrombus, while the secondary endpoint was the complete resolution of atrial thrombus. The prevalence of atrial thrombus in patients with NVAF was 1.4%. Ninety patients with atrial thrombus (mean age 62.8 ± 11.9 years and 61.1% men) were finally analyzed. Atrial thrombus was in the LAA in 82 (91.1%) patients. During follow up, 60% of the patients showed complete resolution of atrial thrombus. Congestive heart failure (odds ratio [OR]: 8.94; 95% confidence interval [CI]: 1.67-47.80) and a history of ischemic stroke (OR: 8.28; 95% CI: 1.48-46.42) were independently associated with the risk of the nonresolution of atrial thrombus. The presence of atrial thrombus in patients with NVAF who received anticoagulation therapy is non-negligible. Even in anticoagulated patients, TEE or cardiac CTA might still be needed. Congestive heart failure and a history of ischemic stroke are risk factors of the nonresolution of atrial thrombus.

Keywords: atrial fibrillation; atrial thrombus; non-vitamin K antagonist oral anticoagulants; resolution; warfarin.

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Conflict of interest statement

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
The study design.
Figure 2.
Figure 2.
Patient flow chart. Abbreviations: CTA, computed tomography angiography; LAA, left atrial appendage; TEE, transesophageal echocardiography
Figure 3.
Figure 3.
The use of oral anticoagulants before the initial TEE or cardiac CTA examination. Abbreviations: CTA, computed tomography angiography; INRF, international normalized ratio; NOAC, non-vitamin K antagonist oral anticoagulants; TEE, transesophageal echocardiography.
Figure 4.
Figure 4.
The adjustment of oral anticoagulants before and after the detection of atrial thrombus.
Figure 5.
Figure 5.
The multi-index ROC curve of the contemporary risk stratification schemes for the nonresolution of atrial thrombus. Abbreviation: ROC, receiver operating characteristic curve.
See this image and copyright information in PMC

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