Changes in Cardiac Thrombus Status after Cerebral Ischemia

BACKGROUND AND PURPOSE: Intracardiac thrombi are a potential source of cerebral embolism. The disposition of intracardiac thrombi in ischemic stroke/transient ischemic attack (TIA) patients was investigated over a 10-month period using omniplanar transesophageal echocardiography (TEE). METHODS: One hundred and five patients underwent TEE examination at <1 month and again at 9-12 months (mean 10 months) after symptom onset. TEEs were evaluated for thrombi in the left atrium, left atrial appendage and left ventricle. Stroke risk factors and TEE findings were compared between patients with and without new thrombi on follow-up TEE. Similar comparisons were made in patients with and without disappearance of thrombi on the follow-up TEE. The effect of anticoagulants was evaluated. RESULTS: Intracardiac thrombi were found initially in 18% (95% CI 11-25%) of patients in 79% (95% CI 61-97%) of whom the thrombi disappeared on the follow-up TEE; this significantly correlated with warfarin anticoagulation (p = 0.037). In the remainder 82% (95% CI 75-89%) patients, new thrombi were detected on the follow-up TEE in 8% (2-14%). These were older (p = 0.009), and not on anticoagulation. Patients with aortic atheroma >/=4 mm were also more likely to develop new intracardiac thrombi (p = 0.001). CONCLUSIONS: Anticoagulation with warfarin for 10 months is associated with conditions leading to disappearance of intracardiac thrombi after a cerebral ischemic event and hence has a probable therapeutic role. Older patients, not anticoagulated, and those with significant aortic atheroma >/=4 mm may have increased probability for de novo thrombus development. These patients may be at risk of cardiac embolization and could be considered for prophylactic anticoagulation.