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Clinical outcomes and thrombus resolution in patients with solid left atrial appendage thrombi: results of a single-center real-world registry

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Abstract

Background

Data on thrombus resolution and clinical outcome data after a therapy of LAA thrombus with novel oral anticoagulants (NOACs) are scarce.

Methods

In this single-center study, we retrospectively analyzed 78 patients diagnosed with a solid LAA thrombus by transesophageal echocardiography (TEE). We assessed baseline clinical and echocardiographic characteristics, the anticoagulatory regimens and outcomes of patients with (responders) and without (non-responders) thrombus resolution.

Results

Mean age was 76.1 ± 8.3 years, patients were male in 57.7% and presented with a high risk for thromboembolism (CHA2DS2-VASc: 4.3 ± 1.1). At thrombus diagnosis, 44.9% patients were treated with a NOAC, while 41.0% were under therapy with a VKA. Complete thrombus resolution was achieved after a mean of 116 ± 79 days in a total of 51.3% of patients, 35.9% showed a reduction of thrombus size, whereas 12.8% showed no changes in thrombus dimensions. There was no statistically significant difference in the rate of LAA thrombus resolution between VKA and NOACs (41.2 vs. 57.1%, p = 0.18). However, in cases in which only the therapy with a NOAC led to complete thrombus resolution, the time needed was significantly shorter than with VKA (81 ± 38 vs. 129 ± 46 days, p = 0.03). Regarding safety outcomes, no differences in bleeding or thromboembolism were observed between patients with and without thrombus resolution.

Conclusions

In this registry, approximately 85% of LAA thrombi were diagnosed in patients with ongoing OAC. Thrombus resolution was observed in nearly 50% of cases. Although there was no difference in the rate of LAA thrombus resolution between VKA and NOACs, the resolution time was shorter in patients prescribed a NOAC.

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Abbreviations

AF:

Atrial fibrillation

CHA2DS2VASC:

CHA2DS2VASC-score

DAPT:

Dual antiplatelet therapy

Dmax/Dmin:

Maximal/minimal diameter (of the LAA thrombus)

DRT:

Device-related thrombus

HASBLED:

HASBLED-score

ISTH:

International Society on Thrombosis and Haemostasis

GFR:

Glomerular filtration rate

LA:

Left atrium

LAA:

Left atrial appendage

LVAD:

Left ventricular assist device

LVEF:

Left ventricular ejection fraction

NOAC:

Novel oral anticoagulant

SEC:

Spontaneous echo contrast

TEE:

Transesophageal echocardiography

VKA:

Vitamin-K antagonist

VTE:

Venous thromboembolism

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Authors and Affiliations

  1. Med. Klinik Und Poliklinik II, Herzzentrum Bonn, Universitätsklinikum Bonn, Bonn, Germany

    Dominik Nelles, Vivian Vij, Vedat Tiyerili, Marcel Weber, Jan Wilko Schrickel, Georg Nickenig, Christoph Hammerstingl & Alexander Sedaghat

  2. Elisabeth Krankenhaus, Essen, Germany

    Moritz Lambers & Robert Schueler

  3. Klinik für Herzchirurgie, Herzzentrum Bonn, Bonn, Germany

    Myriam Schafigh

  4. 2Ai, Polytechnic Institute of Cávado and Ave, Barcelos, Portugal

    Pedro Morais

  5. Zentrum für Herz- Und Gefäßmedizin Köln, Köln, Germany

    Christoph Hammerstingl

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  1. Dominik Nelles
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  10. Georg Nickenig
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Correspondence to Alexander Sedaghat.

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Nelles, D., Lambers, M., Schafigh, M. et al. Clinical outcomes and thrombus resolution in patients with solid left atrial appendage thrombi: results of a single-center real-world registry. Clin Res Cardiol 110, 72–83 (2021). https://doi.org/10.1007/s00392-020-01651-8

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  • DOI: https://doi.org/10.1007/s00392-020-01651-8

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