Key result
Direct oral anticoagulant use was associated with a lower incidence of left atrial appendage thrombus compared to warfarin (6.4% vs 21%; OR 0.4, 95% CI 0.2-0.8) prior to cardioversion or ablation.
Why the study?
The use of transesophageal echocardiography before electrophysiological procedures in anticoagulated patients with atrial fibrillation or flutter is variable, prompting evaluation of the incidence and predictors of left atrial appendage thrombus.
Does direct oral anticoagulant use reduce the incidence of left atrial appendage thrombus compared to warfarin in patients with atrial fibrillation or flutter prior to cardioversion or ablation?
Population
401 patients undergoing electrical cardioversion, AF, or AFl ablation at McGill University Health Center
Design
Retrospective cohort review
Authors
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LAA thrombus in 11% despite anticoagulation warrants caution before cardioversion/ablation; leaves open refined risk stratification in observational data.
Observational (n=401)
No
Does direct oral anticoagulant use reduce the incidence of left atrial appendage thrombus compared to warfarin in patients with atrial fibrillation or flutter prior to cardioversion or ablation?
Odds Ratio: 0.4 (95% CI 0.2–0.8)
Absolute Event Rate: 6.4% vs 21%
LAA thrombus is present in over 10% of patients undergoing TEE before AF/AFl procedures despite anticoagulation, with higher risk in those with heart failure, prior stroke, or taking warfarin rather than DOACs.
Rawahi et al. (2019) conducted an observational in Atrial fibrillation and atrial flutter (n=401). Direct oral anticoagulants vs. Warfarin was evaluated on Intracardiac left atrial appendage (LAA) thrombus on TEE (OR 0.4, 95% CI 0.2-0.8). Direct oral anticoagulant use was associated with a lower incidence of left atrial appendage thrombus compared to warfarin (6.4% vs 21%; OR 0.4, 95% CI 0.2-0.8) prior to cardioversion or ablation.
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