Adding cardiac computed tomography to the acute stroke imaging protocol detected left atrial appendage thrombus in 10.8% (95% CI 7.4-14.2) of patients, guiding early anticoagulation decisions.
Cohort (n=324)
No
What are the factors and clinical management associated with left atrial appendage thrombus detected by cardiac CT in acute ischemic stroke patients?
Adding cardiac CT to acute stroke imaging protocols identifies left atrial appendage thrombus in over 10% of patients, which is associated with higher mortality and may guide early anticoagulation decisions.
BACKGROUND: Detection of left atrial appendage thrombus (LAAt) in acute stroke patients can be improved by cardiac computed tomography using prospective electrocardiogram-gated volume acquisition, which was added to the acute stroke computed tomography protocol in our institution in 2018. AIMS: To evaluate the factors and clinical management associated with LAAt in patients with acute ischemic stroke. METHODS: We retrospectively included 324 consecutive patients with ischemic stroke from November 2018 to October 2019. Clinical data and post-stroke management were compared in LAAt and no-LAAt patients. RESULTS: Thirty-five patients (10.8%; 95%CI 7.4-14.2) had LAAt and 289 had no-LAAt. LAAt patients were significantly older (82 ± 12 vs. 74 ± 14 yo for no-LAAt, p = 0.002), predominantly female (71% vs. 45%, p = 0.004), and were more likely to have previous atrial fibrillation (63% vs. 15%, p 86 ml (odds ratio 5.33; 95%CI 1.70-16.69, p = 0.004) were independently associated with LAAt. More than a third of LAAt patients (37%) received acute heparin therapy compared to 13% of no-LAAt patients (p < 0.001). Moreover, despite comparable stroke severity at admission, the mortality rate was markedly higher in the LAAt group than in the no-LAAt group (37% vs. 13%, p < 0.001). CONCLUSIONS: Cardiac computed tomography for left atrial appendage thrombus evaluation in routine acute stroke imaging protocol could be beneficial for decision-making with regard to the initiation of early anticoagulation.
Bernard et al. (Tue,) conducted a cohort in acute ischemic stroke (n=324). Cardiac computed tomography was evaluated on Left atrial appendage thrombus (LAAt) detection (95% CI 7.4-14.2). Adding cardiac computed tomography to the acute stroke imaging protocol detected left atrial appendage thrombus in 10.8% (95% CI 7.4-14.2) of patients, guiding early anticoagulation decisions.