Prevalence and clinical characteristics associated with left atrial thrombus detection:Apixaban

• 作者: Arun Nagabandi Deepak N Ayyala Gyanendra K Sharma Hoyle L Whiteside Kristen Brown
• 来源期刊: 世界心脏病学杂志:英文版(电子版)
• 学科: 医学
• 关键词: ATRIAL FIBRILLATION ANTICOAGULATION Left ATRIAL appendage THROMBUS TRANSESOPHAGEAL echocardiography
• 年，卷（期）: 2019,（2）
• 页码范围: 84-93
• 页数: 10页
• 分类号: R

摘要

BACKGROUND The prevalence of left atrial appendage(LAA)thrombus detection by transesophageal echocardiogram(TEE)in patients with non-valvular atrial fibrillation(AF)anticoagulated with apixaban is not well defined and identification of additional risk factors may help guide the selection process for pre-procedural TEE.The purpose of our study was to retrospectively analyze the prevalence of LAA thrombus detection by TEE in patients continuously anticoagulated with apixaban for≥4 wk and evaluate for any cardiac risk factors or echocardiographic characteristics which may serve as predictors of thrombus formation.AIM To retrospectively analyze the prevalence of LAA thrombus detection by TEE in patients continuously anticoagulated with apixaban.METHODS Clinical and echocardiographic data for 820 consecutive patients with AF undergoing TEE at Augusta University Medical Center over a four-year period were retrospectively analyzed.All patients(apixaban:226)with non-valvular AF and documented compliance with apixaban for≥4 wk prior to index TEE were included.RESULTS Following≥4 wk of continuous anticoagulation with apixaban,the prevalence of LAA thrombus and LAA thrombus/dense spontaneous echocardiographic contrast was 3.1%and 6.6%,respectively.Persistent AF,left ventricular ejection fraction<30%,severe LA dilation,and reduced LAA velocity were associated with thrombus formation.Following multivariate logistic regression,persistent AF(OR:7.427;95% CI:1.02 to 53.92;P=0.0474),and reduced LAA velocity(OR:1.086;95% CI:1.010 to 1.187;P=0.0489)were identified as independent predictors of LAA thrombus.No Thrombi were detected in patients with a CHA2DS2-VASc score≤1.CONCLUSION Among patients with non-valvular AF and≥4 wk of anticoagulation with apixaban,the prevalence of LAA thrombus detected by TEE was 3.1%.This suggests that continuous therapy with apixaban does not completely eliminate the risk of LAA thrombus and that TEE prior to cardioversion or catheter ablation may be of benefit in patients with multiple risk f