Key result
LA/LAA thrombi occur in ~8% of NOAC-treated AF patients, predicted by obesity and high CHA2DS2-VASc.
Why the study?
Few data were available regarding the prevalence of left atrium thrombi in atrial fibrillation patients treated with non-vitamin K antagonist oral anticoagulants.
What are the prevalence and predictors of left atrial thrombosis in patients with non-valvular atrial fibrillation treated with NOACs prior to cardioversion or ablation?
Observational (n=352)
No
What are the prevalence and predictors of left atrial thrombosis in patients with non-valvular atrial fibrillation treated with NOACs prior to cardioversion or ablation?
In real-world AF patients on NOACs, LA/LAA thrombus prevalence remains notable (7.7%), particularly in those with obesity or CHA2DS2-VASc > 3, highlighting the potential value of pre-procedural TEE in high-risk patients.
Background Few data are available regarding the prevalence of left atrium (LA) thrombi in atrial fibrillation (AF) patients treated with non-vitamin K antagonist oral anticoagulants (NOACs). Methods: We evaluated the prevalence and predictors of LA/LA appendage (LAA) thrombi in non-valvular AF patients treated with NOACs referring to a single centre for a scheduled electrical cardioversion (ECV) or catheter ablation (CA). Transesophageal echocardiography (TEE) was performed within 12 h prior to the index procedure.Results A total of 352 consecutive patients with non-valvular AF treated with NOACs were included in this analysis (ECV group n = 176 and CA group n = 176) between 2013 and 2018. 85 patients (24.2%) were on dabigatran, 150 (42.7%) on rivaroxaban, 104 (29.6%) on apixaban and 13 (3.7%) on edoxaban. A LA/LAA thrombus was detected by TEE in 27 (7.7%) patients, 18 in the ECV group and nine in the ablation group; 18 (5.1%) patients presented dense LA/LAA spontaneous echo contrast (SEC). Predictors of LA/LAA thrombi were a CHA2DS2-VASc score > 3 (OR 4.54, 95% CI 1.50 − 13.70, p value = .007) and obesity (OR 6.01, 95% CI 1.95 − 18.50, p value = .001).Conclusions Among real-world patients with non-valvular AF treated with NOACs, we found a high incidence of LA/LAA thrombi compared to previous reports. The main predictors of LA/LAA thrombosis were a CHA2DS2-VASc score > 3 and obesity.
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Angelini et al. (2021) conducted an observational in non-valvular atrial fibrillation (n=352). NOACs was evaluated on LA/LAA thrombus detected by TEE. In non-valvular AF patients treated with NOACs, LA/LAA thrombi were detected in 7.7%, with CHA2DS2-VASc score >3 (OR 4.54) and obesity (OR 6.01) as significant predictors.
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