Key result
Thrombosis in the left atrium or its appendage is detected in 4-19% of patients with non-valvular atrial fibrillation, with at least 50% of these patients having a low CHADS2/CHA2DS2-VASc score.
Why the study?
Data on left atrial and left atrial appendage thrombosis frequency in non-valvular atrial fibrillation are primarily from small cohorts undergoing specific procedures, leaving broader data limited.
LA/LAA thrombosis occurs in 4-19% of NVAF patients and is often present despite low clinical risk scores or adequate anticoagulant therapy.
Thrombus detection rates in NVAF highlight ongoing therapy gaps; leaves open optimal strategies pending larger prospective data.
The review presents data on the frequency of thrombosis detection in the left atrium (LA and/or its appendage (LAA) in patients with non-valvular atrial fibrillation (NVAF), characterizes their connection with antithrombotic therapy and the presence of cardiovascular risk factors. It was demonstrated that thrombosis in LA/LAA is detected in 4-19% of cases. At the same time, data on thrombus frequency in LA/LAA were obtained by examination of small cohorts of patients with AF, who were subjected to transesophageal echocardiography before catheter isolation of pulmonary vein ostia, cardioversion, installation of occluders in LAA. Information about thrombosis frequency in the LA/LAA without these procedures is extremely limited. The frequency of thrombus detection in LA/LAA varies depending on the population studied, the presence of cardiovascular risk factors (diabetes mellitus, metabolic syndrome, arterial hypertension, chronic kidney disease, chronic heart failure) and peculiarities of anticoagulant therapy. CHADS2 and CHA2DS2-VASc scales do not sufficiently predict the presence of thrombus in LA/LAA. For example, at least 50% of patients with LA/LAA thrombus may have a low score on these scales and therefore the risk of heart thromboembolism will be underestimated. According to the facts, adequate anticoagulant therapy does not guarantee the absence of a thrombus in the LA/LAA. Approximately 40% of thrombotic formation cases in LA/LAA do not disappear after 1 year of antithrombotic treatment.
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Zaigrayev et al. (2020) conducted a review in non-valvular atrial fibrillation (NVAF). Non-valvular atrial fibrillation was evaluated on Thrombosis detection in the left atrium and/or its appendage. Thrombosis in the left atrium or its appendage is detected in 4-19% of patients with non-valvular atrial fibrillation, with at least 50% of these patients having a low CHADS2/CHA2DS2-VASc score.