Non-vitamin K oral anticoagulants versus warfarin for left atrial appendage thrombus resolution in nonvalvular atrial fibrillation or flutter.
atrial fibrillation
atrial flutter
left atrial thrombus
oral anticoagulation
Journal
Pacing and clinical electrophysiology : PACE
ISSN: 1540-8159
Titre abrégé: Pacing Clin Electrophysiol
Pays: United States
ID NLM: 7803944
Informations de publication
Date de publication:
09 2019
09 2019
Historique:
received:
31
05
2019
revised:
10
07
2019
accepted:
26
07
2019
pubmed:
30
7
2019
medline:
8
8
2020
entrez:
30
7
2019
Statut:
ppublish
Résumé
Non-vitamin K oral anticoagulants (NOACs) have emerged as alternatives to vitamin K antagonists in select situations. For left atrial (LA) appendage thrombus in nonvalvular atrial fibrillation (AF) or flutter, guidelines recommend oral anticoagulation (OAC) for at least 3 weeks prior to reassessment. Data comparing NOACs to warfarin in this scenario are scarce. A retrospective study identified subjects with nonvalvular AF or flutter who were: a) noted to have LA thrombus detected on transesophageal echocardiography (TEE), b) previously not receiving long-term OAC; and c) evaluated for resolution of LA thrombus by follow-up TEE between 3 weeks to less than 1 year of the initial TEE. The study included 45 subjects with mean age 63.2 years, 69% male, 78% white race/ethnicity, 42% paroxysmal, and mean CHA In patients nonvalvular AF or flutter who were OAC naïve at the time of diagnosis with LA appendage thrombus, complete resolution was similar between NOACs and warfarin.
Sections du résumé
BACKGROUND
Non-vitamin K oral anticoagulants (NOACs) have emerged as alternatives to vitamin K antagonists in select situations. For left atrial (LA) appendage thrombus in nonvalvular atrial fibrillation (AF) or flutter, guidelines recommend oral anticoagulation (OAC) for at least 3 weeks prior to reassessment. Data comparing NOACs to warfarin in this scenario are scarce.
METHODS
A retrospective study identified subjects with nonvalvular AF or flutter who were: a) noted to have LA thrombus detected on transesophageal echocardiography (TEE), b) previously not receiving long-term OAC; and c) evaluated for resolution of LA thrombus by follow-up TEE between 3 weeks to less than 1 year of the initial TEE.
RESULTS
The study included 45 subjects with mean age 63.2 years, 69% male, 78% white race/ethnicity, 42% paroxysmal, and mean CHA
CONCLUSIONS
In patients nonvalvular AF or flutter who were OAC naïve at the time of diagnosis with LA appendage thrombus, complete resolution was similar between NOACs and warfarin.
Substances chimiques
Anticoagulants
0
Warfarin
5Q7ZVV76EI
Types de publication
Comparative Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1183-1190Commentaires et corrections
Type : CommentIn
Type : CommentIn
Informations de copyright
© 2019 Wiley Periodicals, Inc.
Références
Naccarelli GV, Varker H, Lin J, Schulman KL. Increasing prevalence of atrial fibrillation and flutter in the United States. Am J Cardiol. 2009;104:1534-1539.
Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation as an independent risk factor for stroke: The Framingham study. Stroke. 1991;22:983-988.
Blackshear JL, Odell JA. Appendage obliteration to reduce stroke in cardiac surgical patients with atrial fibrillation. Ann Thorac Surg. 1996;61:755-759.
January CT, Wann LS, Alpert JS, et al. AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: A report of the American college of cardiology/american heart association task force on practice guidelines and the heart rhythm society. Circulation. 2014;130:e199-e267.
January CT, Wann LS, Calkins H, et al. AHA/ACC/HRS focused update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: A report of the American college of cardiology/american heart association task force on clinical practice guidelines and the heart rhythm society. Circulation. 2019;140:e125-e151.
Seidl K, Rameken M, Drögemüller A, et al. Embolic events in patients with atrial fibrillation and effective anticoagulation: Value of transesophageal echocardiography to guide direct-current cardioversion: Final results of the Ludwigshafen Observational Cardioversion Study. J Am Coll Cardiol. 2002;39:1436-1442.
Zhan Y, Joza J, Al Rawahi M, et al. Assessment and management of the left atrial appendage thrombus in patients with nonvalvular atrial fibrillation. Can J Cardiol. 2018;34:252-261.
Wang NC, Sather MD, Hussain A, et al. Oral anticoagulation and left atrial thrombi resolution in nonrheumatic atrial fibrillation or flutter: A systematic review and meta-analysis. Pacing Clin Electrophysiol. 2018;41:767-774.
Martins RP, Galand V, Colette E, et al. Defining nonvalvular atrial fibrillation: A quest for clarification. Am Heart J. 2016;178:161-167.
Kovacs RJ, Flaker GC, Saxonhouse SJ, et al. Practical management of anticoagulation in patients with atrial fibrillation. J Am Coll Cardiol. 2015;65:1340-1360.
Hahn RT, Abraham T, Adams MS, et al. Guidelines for performing a comprehensive transesophageal examination: Recommendations from the American society of echocardiography and the society of cardiovascular anesthesiologist. J Am Soc Echocardiogr. 2016;26:922-964.
Lowe BS, Kusunose K, Motoki H, et al. Prognostic significance of left atrial appendage “sludge” in patients with atrial fibrillation: A new transesophageal echocardiographic thromboembolic risk factor. J Am Soc Echocardiogr. 2014;27:1176-1183.
Schulman S, Kearon C. Subcommittee on control of anticoagulation of the scientific and standardization committee of the international society on thrombosis and haemostasis. Definition of major bleeding in clinical investigations of antihemostatic medicinal products in non-surgical patients. J Thromb Haemost. 2005;3:692-694.
Suissa S. Immortal time bias in pharmacoepidemiology. Am J Epidemiol. 2007;167:492-499.
Eikelboom JW, Connolly SJ, Brueckmann M, et al. Dabigatran versus warfarin in patients with mechanical heart valves. N Engl J Med. 2013;369:1206-1214.
Harada M, Van Wagoner DR, Nattel S. Role of inflammation in atrial fibrillation pathophysiology and management. Circ J. 2015;79:495-502.
Collins LJ, Silverman DI, Douglas PS, Manning WJ. Cardioversion of nonrheumatic atrial fibrillation: Reduced thromboembolic complications with 4 weeks of precardioversion anticoagulation are related to atrial thrombus resolution. Circulation. 1995;92:160-163.
Rodriguez Y, Althouse AD, Adelstein EC, et al. Characteristics and outcomes of concurrently diagnosed new rapid atrial fibrillation or flutter and new reduced ejection fraction. Pacing Clin Electrophysiol. 2016;39:1394-1403.
Hao L, Zhong J, Zhang W, et al. Uninterrupted dabigatran versus warfarin in the treatment of intracardiac thrombus in patients with non-valvular atrial fibrillation. Int J Cardiol. 2015;190:63-66.
Lip GYH, Hammerstingl C, Marin F, et al. Left atrial thrombus resolution in atrial fibrillation or flutter: Results of a prospective study with rivaroxaban (X-TRA) and a retrospective observational registry providing baseline data (CLOT-AF). Am Heart J. 2016;178:126-134.
Xing XF, Liu NN, Han YL, Zhou WW, Liang M, Wang ZL. Anticoagulation efficacy of dabigatran etexilate for left atrial appendage thrombus in patients with atrial fibrillation by transthoracic and transesophageal echocardiography. Medicine. 2018;97:e11117.
Fleddermann A, Eckert R, Muskala P, Hayes C, Magalski A, Main ML. Efficacy of direct acting oral anticoagulant drugs in treatment of left atrial appendage thrombus in patients with atrial fibrillation. Am J Cardiol. 2019;123:57-62.
Ke HH, He Y, Lv XW, Zhang EH, Wei Z, Li JY. Efficacy and safety of rivaroxaban on the resolution of left atrial/left atrial appendage thrombus in nonvalvular atrial fibrillation patients. J Thromb Thrombolysis. 2019;48:270-276.
Ferner M, Wachtlin D, Konrad T, et al. Rationale and design of the RE-LATED AF-AFNET 7 trial: Resolution of left atrial-appendage thrombus-effects of dabigatran in patients with atrial fibrillation. Clin Res Cardiol. 2016;105:29-36.