Key result
Left atrial thrombus developed in 4% of patients with atrial fibrillation receiving dabigatran before electrical cardioversion, and was more likely in older patients with higher CHADS2 scores.
Why the study?
Does dabigatran therapy prevent left atrial thrombus formation in patients with atrial fibrillation undergoing electrical cardioversion?
Observational (n=198)
Yes
Does dabigatran therapy prevent left atrial thrombus formation in patients with atrial fibrillation undergoing electrical cardioversion?
Left atrial thrombus occurs in approximately 4% of atrial fibrillation patients receiving dabigatran before cardioversion, particularly in older patients on lower doses, but often resolves with dose escalation or prolonged therapy.
Answers are grounded in this paper and cite their sources.
May warrant pre-cardioversion TEE in higher-risk AF patients on dabigatran; leaves open optimal regimens in prospective trials.
BACKGROUND: Protocols on the use of novel oral anticoagulants for stroke prevention in patients with atrial fibrillation (AF) undergoing electrical cardioversion (ECV) are lacking. AIM: The study was aimed at evaluating the efficacy of dabigatran (Dabi) treatment in preventing peri-ECV stroke. METHODS: A retrospective survey of the incidence and fate of left atrial (LA) thrombus during Dabi therapy in patients with AF was conducted between December 2012 and January 2013 by the Japanese Heart Rhythm Society. RESULTS: A total of 198 patients from 299 institutions underwent transesophageal echocardiography (TEE) to rule out LA thrombus before ECV. Of these, LA thrombus was found in eight patients (4%), who tended to be older (67.3 vs. 61.3 years, p=0.175), had higher CHADS2 scores (1.88 vs. 0.95, p=0.058), and a higher prevalence of prior stroke or transient ischemic attack (22.2% vs. 2.6%, p=0.034) than those without LA thrombus. Of the eight patients with LA thrombus, one had LA thrombus during a Dabi 150 mg b.i.d treatment, whereas the remaining seven were receiving 110 mg b.i.d for 3 weeks or longer. In 6 of the 8 patients with LA thrombus, a second TEE was performed, revealing complete resolution of LA thrombus in five; among these five patients, one received Dabi dosage of 150 mg b.i.d unchanged, two received an increased dosage from 110 mg to 150 mg b.i.d, and two were switched to warfarin. Two patients had a stroke 3 and 15 days after ECV, and one had a major large intestine bleeding episode during Dabi therapy. CONCLUSIONS: LA thrombus developed in 4% of patients with AF receiving Dabi. Older patients with a higher CHADS2 score receiving a lower Dabi dosage were more likely to develop LA thrombus, which was resolved with a prolonged or increased dosage. A higher Dabi dosage may be more beneficial before ECV but prospective randomized studies would be needed to confirm these results.
No takes yet. Share an insight, caveat, or question.
Mitamura et al. (2015) conducted an observational in Atrial fibrillation (n=198). Dabigatran was evaluated on Incidence of left atrial thrombus. Left atrial thrombus developed in 4% of patients with atrial fibrillation receiving dabigatran before electrical cardioversion, and was more likely in older patients with higher CHADS2 scores.
Synapse has enriched 10 related papers. Consider them for comparative context: