Preview

Rational Pharmacotherapy in Cardiology

Advanced search

Efficiency of the Left Atrial Appendage Thrombus Dissolution in Patients with Persistent Nonvalvular Atrial Fibrillation with Warfarin or Direct Oral Anticoagulants Therapy

https://doi.org/10.20996/1819-6446-2021-10-08

Full Text:

Abstract

Aim. Compare the incidence of the left atrial appendage (LAA) thrombus dissolution in patients with persistent nonvalvular atrial fibrillation receiving warfarin and direct oral anticoagulants (DOAC).

Materials and methods. 68 patients with persistent nonvalvular atrial fibrillation were included in a retrospective study (age was 59.7±9.8 years, 60.3% men), in whom at least one repeated transesophageal echocardiographic examination was performed after detecting a thrombus. After detecting a thrombus in the LAA, 37 (54.4%) patients started or continued taking warfarin in doses that ensure the INR maintenance at the level of 2-3, 14 (20.6%) started or continued taking dabigatran at a dose of 150 mg 2 times/day, 14 (20.6%) started or continued taking rivaroxaban 20 mg 1 time/day and 3 (4.4%) started or continued taking apixaban 5 mg 2 times/day. Repeated transesophageal echocardiographic examination was performed on average 33.3±14.2 days after the first one.

Results. Dissolution of a previously identified thrombus was found in 26 (83.9%) of 31 patients receiving DOAC and in 19 (51.4%) of 37 patients receiving warfarin (p=0.011). The logistic regression analysis showed that the chances of a thrombus dissolution in LAA while taking DOAC are 14.8 times (95% confidence interval [CI] was 2.469-88.72) higher than while taking warfarin. The size and the rate at which blood is expelled from the LAA also have an independent influence on the chances of thrombus dissolution. An increase in the size of a thrombus by 1 mm reduces the chances of a thrombus dissolution by 1.136 (95% CI was 1.040-1.244) times, and an increase in the rate of blood expulsion from the LAA by 1 cm/sec increases these chances by 1.105 (95% CI was 1.003-1.219) times.

Conclusion. In the present study, the incidence of the LAA thrombus dissolution in patients with persistent nonvalvular atrial fibrillation while receiving DOAC was higher than while receiving warfarin.

About the Authors

E. S. Mazur
Tver State Medical University
Russian Federation

Evgeniy S. Mazur

eLibrary SPIN 3898-6719



V. V. Mazur
Tver State Medical University
Russian Federation

Vera V. Mazur

eLibrary SPIN 9798-0540



N. D. Bazhenov
Tver State Medical University
Russian Federation

Nikolay D. Bazhenov

eLibrary SPIN 1053-3892



Yu. A. Orlov
Tver State Medical University
Russian Federation

Yuriy A. Orlov

eLibrary SPIN 8518-2831



References

1. Arakelyan MG, Bockeria LA, Vasilieva EYu, et al. 2020 Clinical guidelines for Atrial fibrillation and atrial flutter. Russian Journal of Cardiology. 2021;26(7):4594 (In Russ.) DOI:10.15829/1560-4071-2021-4594.

2. Hindricks G, Potpara T, Dagres N, et al.; ESC Scientific Document Group. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J. 2021;42(5):373-498. DOI:10.1093/eurheartj/ehaa612.

3. Lip GY, Hammerstingl C, Marin F, et al.; X-TRA study and CLOT-AF registry investigators. Left atrial thrombus resolution in atrial fibrillation or flutter: Results of a prospective study with rivaroxaban (X-TRA) and a retrospective observational registry providing baseline data (CLOT-AF). Am Heart J. 2016;178:126-34. DOI:10.1016/j.ahj.2016.05.007.

4. Hussain A, Katz WE, Genuardi MV, et al. Non-vitamin K oral anticoagulants versus warfarin for left atrial appendage thrombus resolution in nonvalvular atrial fibrillation or flutter. Pacing Clin Electrophysiol. 2019;42(9):1183-90. DOI:10.1111/pace.13765.

5. Niku AD, Shiota T, Siegel RJ, Rader F. Prevalence and Resolution of Left Atrial Thrombus in Patients with Nonvalvular Atrial Fibrillationand Flutter with Oral Anticoagulation. Am J Cardiol. 2019;23(1):63-8. DOI:10.1016/j.amjcard.2018.09.027.

6. Ferner M, Wachtlin D, Konrad T, et al. Rationale and design of the RE-LATED AF-AFNET 7 trial: REsolution of Leftatrial-Appendage Thrombus-Effects of Dabigatran in patients with Atrial Fibrillation. Clin Res Cardiol. 2016;105(1):29-36. DOI:10.1007/s00392-015-0883-7.

7. Kropacheva ES. Intracardiac thrombosis: frequency, risk factors and place of oral anticoagulants in treatment. Atherothrombosis. 2020;(1):134-52 (In Russ.) DOI:10.21518/2307-1109-2020-1-134-152.

8. Mumoli N, Amellone C, Antonelli G, et al. Clinical discussions in antithrombotic therapy management in patients with atrial fibrillation: a Delphi consensus panel. CJC Open 2020;2(6):641-51. DOI:10.1016/j.cjco.2020.07.016.

9. Xing FX, Liu NN, Han YL, et al. Anticoagulation efficacy of dabigatran etexilate for left atrial appendage thrombus in patients with atrial fibrillation by transthoracic and transesophageal echocardiography. Medicine (Baltimore). 2018;97(26):e11117. DOI:10.1097/MD.0000000000011117.

10. Harada M, Koshikawa M, Motoike Y, et al. Left Atrial Appendage Thrombus Prior to Atrial Fibrillation Ablation in the Era of Direct Oral Anticoagulants. Circ J. 2018;82(11):2715-21. DOI:10.1253/circj.CJ-18-0398.

11. Yilmaz KC, Ciftci O, Ozin B, Muderrisoglu H. Anticoagulants in left atrial thrombus resolution. Ann Med Res. 2020;27(7):1908-12. DOI:10.5455/annalsmedres.2020.03.284.

12. Farag SI, Arafa OS, Hassan AAE, et al. Real-Life International Normalized Ratio Profile in Patients with Non-Valvular Atrial Fibrillation Prescribed Vitamin K Antagonist. Rational Pharmacotherapy in Cardiology. 2020;16(4):522-7 (In Russ.) DOI:10.20996/1819-6446-2020-08-14.

13. Skirdenko YP, Nikolaev NA. Algorithm for the Choice of Anticoagulant for Patients with Atrial Fibrillation. Rational Pharmacotherapy in Cardiology. 2020;16(2):199-205 (In Russ.) DOI:10.20996/1819-6446-2020-04-16.

14. Lattuca B, Bouziri N., Kerneis M, et al. Antithrombotic Therapy for Patients With Left Ventricular Mural Thrombus. J Am Coll Cardiol. 2020;75(14):1676-85. DOI:10.1016/j.jacc.2020.01.057.

15. Oh JK, Park JH, Lee JH, et al. Shape and Mobility of a Left Ventricular Thrombus Are Predictors of Thrombus Resolution. Korean Circ J. 2019;49(9):829-37. DOI:10.4070/kcj.2018.0346.


For citation:


Mazur E.S., Mazur V.V., Bazhenov N.D., Orlov Yu.A. Efficiency of the Left Atrial Appendage Thrombus Dissolution in Patients with Persistent Nonvalvular Atrial Fibrillation with Warfarin or Direct Oral Anticoagulants Therapy. Rational Pharmacotherapy in Cardiology. 2021;17(5):724-728. https://doi.org/10.20996/1819-6446-2021-10-08

Views: 109


Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.


ISSN 1819-6446 (Print)
ISSN 2225-3653 (Online)