Key result
The prevalence of left atrial appendage thrombus was not significantly different between atrial fibrillation patients treated with continuous dabigatran (5%) and rivaroxaban (3.2%) (p=0.1145).
Why the study?
Left atrial appendage thrombus may occur despite continuous anticoagulation therapy, and factors predisposing to thrombus formation during dabigatran or rivaroxaban treatment required examination.
Does dabigatran compared to rivaroxaban affect the incidence of left atrial appendage thrombus in atrial fibrillation patients undergoing electrical cardioversion or catheter ablation?
Cohort (n=1,256)
Yes
Does dabigatran compared to rivaroxaban affect the incidence of left atrial appendage thrombus in atrial fibrillation patients undergoing electrical cardioversion or catheter ablation?
Absolute Event Rate: 5% vs 3.2%
p-value: p=0.1145
The risk of left atrial appendage thrombus is similar between continuous dabigatran and rivaroxaban therapy in AF patients prior to cardioversion or ablation, and the CHA2DS2-VASc-RAF scale offers high predictive value for identifying at-risk patients.
Comparable LAAT rates with dabigatran and rivaroxaban should not yet guide agent selection; leaves open optimal periprocedural strategies in AF.
Left atrial appendage thrombus (LAAT) may be detected by transesophageal echocardiography (TOE) in patients with atrial fibrillation (AF) despite continuous anticoagulation therapy. We examined the factors predisposing to LAAT in patients treated with the anticoagulants dabigatran and rivaroxaban. We retrospectively evaluated 1,256 AF patients from three centres who underwent TOE before electrical cardioversion ( n = 611, 51.4%) or catheter ablation ( n = 645, 48.6%) from January 2013 to December 2019 and had been on at least three weeks of continuous dabigatran ( n = 603, 48%) or rivaroxaban ( n = 653, 52%) therapy. Preprocedural TOE diagnosed LAAT in 51 patients (4.1%), including 30 patients (5%) treated with dabigatran and 21 patients (3.2%) treated with rivaroxaban (p=0.1145). In multivariate logistic regression, predictors of LAAT in patients treated with dabigatran were non-paroxysmal AF (vs. paroxysmal AF) (OR = 6.2, p=0.015), heart failure (OR = 3.22, p=0.003), and a eGFR <60 ml/min/1.73 m 2 (OR = 2.65, p=0.012); the predictors in patients treated with rivaroxaban were non-paroxysmal AF (vs. paroxysmal AF) (OR = 5.73, p=0.0221) and heart failure (OR = 3.19, p=0.116). In ROC analysis of the dabigatran group, the area under the curve (AUC) for the CHA 2 DS 2 -VASc-RAF score was significantly higher (0.78) than those for the CHADS 2 , CHA 2 DS 2 -VASc, and R 2 CHADS 2 scores (0.67, 0.70, and 0.72, respectively). In the rivaroxaban group, the CHA 2 DS 2 -VASc-RAF score also performed significantly better (AUC of 0.77) than the CHADS 2 , CHA 2 DS 2 -VASc, and R 2 CHADS 2 scores (AUC of 0.66, 0.64, and 0.67, respectively). The risk of LAAT was the same for patients in both treatment groups. In all patients, non-paroxysmal AF or heart failure, and in patients treated with dabigatran an eGFR <60 ml/min/1.73 m 2 , were independent predictors of LAAT. The new CHA 2 DS 2 -VASc-RAF scale had the highest predictive value for LAAT in the entire study population.
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Gorczyca−Michta et al. (2020) conducted a cohort in Atrial fibrillation (n=1,256). Dabigatran vs. Rivaroxaban was evaluated on Left atrial appendage thrombus (LAAT) (p=0.1145). The prevalence of left atrial appendage thrombus was not significantly different between atrial fibrillation patients treated with continuous dabigatran (5%) and rivaroxaban (3.2%) (p=0.1145).
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