Key result
In patients with atrial fibrillation and left atrial appendage thrombus despite anticoagulation, any change in treatment was more effective for thrombus resolution than no change (OR 2.97).
Why the study?
The comparative effectiveness of different anticoagulation strategies for AF patients presenting with LAA thrombus despite chronic OAC and scheduled for cardioversion or ablation was not established.
Does changing anticoagulation treatment improve LAA thrombus resolution compared to no change in AF patients with LAA thrombus despite chronic OAC?
Cohort (n=129)
No
Does changing anticoagulation treatment improve LAA thrombus resolution compared to no change in AF patients with LAA thrombus despite chronic OAC?
In AF patients with LAA thrombus despite chronic OAC, changing the anticoagulation strategy improves thrombus resolution compared to no change, though overall resolution rates remain around 50%.
Answers are grounded in this paper and cite their sources.
No anticoagulation strategy proved superior for resolving persistent LAA thrombus; leaves open optimal approach pending prospective trials.
PURPOSE: To compare effectiveness of different treatments for atrial fibrillation (AF) patients who were scheduled for cardioversion (CV) or ablation (CA) presenting with left atrium appendage (LAA) thrombus despite chronic oral anticoagulation therapy (OAC). METHODS: This was a retrospective cohort study. We analyzed 2014-2019 medical records of patients scheduled for CV or CA of AF who were diagnosed with LAA thrombus despite optimal OAC and had a follow-up transesophageal echocardiogram (TOE). Changes in treatment were divided into the following groups: switch to a drug with different mechanism of action, switch to a drug with similar mechanism of action, initiation of combination therapy, or deliberate no change in treatment. Patients with contraindications to non-vitamin K antagonists were excluded from the analysis. RESULTS: We analyzed data of 129 patients comprising 181 cycles of treatment. The overall effectiveness of LAA thrombus dissolution was 51.9% regardless of the number of cycles and 42.6% for the first cycle of treatment. Any change of treatment was more effective than deliberate no change-OR 2.97 [95% CI: 1.07-8.25], P = 0.031, but no particular strategy seemed to be more effective than the other. Left atrium area (OR 0.908 [95% CI: 0.842-0.979]) and number of treatment cycles (OR 0.457 [95% CI: 0.239-0.872]) were both adversely related to thrombus resolution. There was one ischemic and three bleeding adverse events during the treatment. CONCLUSION: LAA thrombus resolution in patients already on OAC may require a change of previous OAC treatment but the overall effectiveness of dissolution seems to be about 50%.
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Kołakowski et al. (2021) conducted a cohort in Atrial fibrillation or flutter with left atrial appendage thrombus despite chronic oral anticoagulation (n=129). Change in oral anticoagulation treatment vs. Deliberate no change in treatment was evaluated on Left atrial appendage thrombus resolution (OR 2.97, 95% CI 1.07-8.25, p=0.031). In patients with atrial fibrillation and left atrial appendage thrombus despite anticoagulation, any change in treatment was more effective for thrombus resolution than no change (OR 2.97).
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