Key result
Sinus rhythm restoration without adequate anticoagulant preparation leads to thromboembolic events in 5-7% of patients, necessitating effective strategies for left atrial appendage thrombus resolution.
Why the study?
The best management strategy to dissolve left atrial appendage thrombus in patients who develop it despite oral anticoagulation treatment remains unclear due to a lack of adequately powered studies.
What is the effectiveness of various oral anticoagulation strategies on left atrial appendage thrombus resolution in patients with atrial fibrillation undergoing cardioversion?
What is the effectiveness of various oral anticoagulation strategies on left atrial appendage thrombus resolution in patients with atrial fibrillation undergoing cardioversion?
The optimal management strategy for left atrial appendage thrombus resolution in patients with atrial fibrillation on oral anticoagulation remains unclear due to a lack of adequately powered studies.
Highlights thromboembolic risk without adequate anticoagulation before cardioversion; leaves open optimal regimen for left atrial appendage thrombus resolution.
Atrial fibrillation (AF) remains the most common arrhythmia. The sinus rhythm restoration procedure without adequate anticoagulant preparation may lead to a thromboembolic event in approximately 5-7% of patients. The initiation of oral anticoagulation significantly reduces this risk by inhibiting formation of embolic material in the heart cavities, especially in the left atrial appendage (LAA). However, there is a group of patients who develop embolic material in the LAA despite oral anticoagulation treatment. The best treatment method to dissolve thrombus in the LAA is not clear, due to the lack of studies with adequate power and endpoints that can determine the best management strategy. We present clinical trials comparing the efficacy and safety of oral anticoagulants in patients undergoing AF cardioversion. We evaluate the frequency of LAA thrombus formation in patients with AF on treatment with oral anticoagulants. Furthermore, we discuss the effectiveness of various treatment strategies on LAA thrombus resolution.
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Karwowski et al. (2023) conducted a review in Atrial fibrillation. Oral anticoagulants was evaluated. Sinus rhythm restoration without adequate anticoagulant preparation leads to thromboembolic events in 5-7% of patients, necessitating effective strategies for left atrial appendage thrombus resolution.
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