Persistent Left Atrial Appendage Thrombus in Atrial Fibrillation Despite Anticoagulation
Key result
Preprocedural TEE reveals LAA thrombus in ~2% of AF patients despite compliant oral anticoagulation.
- n=3,653
Why the study?
Guidelines consider 4 weeks of uninterrupted OAC sufficient to avoid TEE, but some AF patients exhibit persistent LAA thrombus despite compliance.
What are the characteristics and management outcomes of patients with persistent LAA thrombus despite compliance with oral anticoagulation?
Population
3653 patients undergoing preprocedural TEE for an AF related procedure
Design
Retrospective cohort study
Authors
Discussion
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Member takes
Implication
May support preprocedural TEE despite OAC compliance; leaves open optimal management of persistent LAA thrombus.
Study Design
Type
Observational (n=3,653)
Structured PICO
What are the characteristics and management outcomes of patients with persistent LAA thrombus despite compliance with oral anticoagulation?
P
Population
3,653 patients presenting for an atrial fibrillation-related procedure who underwent preprocedural transesophageal echocardiography (TEE) between 2021 and 2024, focusing on 39 patients with left atrial appendage (LAA) thrombus despite compliance with oral anticoagulation for at least 4 weeks.
I
Intervention
Management strategies for persistent LAA thrombus, including switching oral anticoagulation, maintaining the same agent for a longer period, or left atrial appendage occlusion (LAA-O).
O
Outcome
Presence of LAA thrombus on preprocedural TEE despite compliance with oral anticoagulation.surrogate
A small but clinically significant proportion of high-risk AF patients develop LAA thrombus despite compliant OAC use, challenging the guideline assumption that 4 weeks of OAC universally obviates the need for preprocedural TEE.
Cite This Study
Kushnir et al. (2025) conducted an observational in Atrial Fibrillation (n=3,653). Oral anticoagulation was evaluated on Presence of LAA thrombus on preprocedural TEE. Preprocedural TEE revealed LAA thrombus in 1.8% (65/3653) of patients presenting for an AF-related procedure, including 39 patients who were compliant with oral anticoagulation for ≥4 weeks.