Key result
Apixaban therapy for ≥4 weeks in patients with non-valvular atrial fibrillation was associated with a 3.1% prevalence of left atrial appendage thrombus detected by transesophageal echocardiography.
Why the study?
The prevalence of LAA thrombus detected by TEE in patients with non-valvular AF anticoagulated with apixaban is not well defined, and identifying risk factors may guide pre-procedural TEE selection.
Observational (n=226)
No
Continuous apixaban therapy for ≥ 4 weeks does not completely eliminate the risk of LAA thrombus (3.1% prevalence), suggesting pre-procedural TEE remains beneficial in patients with multiple risk factors like persistent AF and reduced LAA velocity.
Answers are grounded in this paper and cite their sources.
Residual LAA thrombus risk warrants caution with apixaban alone; leaves open optimal pre-procedural imaging in high-risk non-valvular AF.
BACKGROUND: The prevalence of left atrial appendage (LAA) thrombus detection by transesophageal echocardiogram (TEE) in patients with non-valvular atrial fibrillation (AF) anticoagulated with apixaban is not well defined and identification of additional risk factors may help guide the selection process for pre-procedural TEE. The purpose of our study was to retrospectively analyze the prevalence of LAA thrombus detection by TEE in patients continuously anticoagulated with apixaban for ≥ 4 wk and evaluate for any cardiac risk factors or echocardiographic characteristics which may serve as predictors of thrombus formation. AIM: To retrospectively analyze the prevalence of LAA thrombus detection by TEE in patients continuously anticoagulated with apixaban. METHODS: Clinical and echocardiographic data for 820 consecutive patients with AF undergoing TEE at Augusta University Medical Center over a four-year period were retrospectively analyzed. All patients (apixaban: 226) with non-valvular AF and documented compliance with apixaban for ≥ 4 wk prior to index TEE were included. RESULTS: Following ≥ 4 wk of continuous anticoagulation with apixaban, the prevalence of LAA thrombus and LAA thrombus/dense spontaneous echocardiographic contrast was 3.1% and 6.6%, respectively. Persistent AF, left ventricular ejection fraction < 30%, severe LA dilation, and reduced LAA velocity were associated with thrombus formation. Following multivariate logistic regression, persistent AF (OR: 7.427; 95%CI: 1.02 to 53.92; P = 0.0474), and reduced LAA velocity (OR: 1.086; 95%CI: 1.010 to 1.187; P = 0.0489) were identified as independent predictors of LAA thrombus. No Thrombi were detected in patients with a CHA(2)DS(2)-VASc score ≤ 1. CONCLUSION: Among patients with non-valvular AF and ≥ 4 wk of anticoagulation with apixaban, the prevalence of LAA thrombus detected by TEE was 3.1%. This suggests that continuous therapy with apixaban does not completely eliminate the risk of LAA thrombus and that TEE prior to cardioversion or catheter ablation may be of benefit in patients with multiple risk factors.
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Whiteside et al. (2019) conducted an observational in Non-valvular atrial fibrillation (n=226). Apixaban was evaluated on Prevalence of left atrial appendage thrombus detection. Apixaban therapy for ≥4 weeks in patients with non-valvular atrial fibrillation was associated with a 3.1% prevalence of left atrial appendage thrombus detected by transesophageal echocardiography.
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