Changes in cardiac thrombus status after cerebral ischemia

Area of Science:

• Cardiology
• Neurology
• Vascular Medicine

Background:

• Intracardiac thrombi pose a risk for cerebral embolism in patients with ischemic stroke or transient ischemic attack (TIA).
• Understanding thrombus disposition is crucial for managing stroke risk.

Purpose of the Study:

• To investigate the fate of intracardiac thrombi in ischemic stroke/TIA patients over a 10-month period.
• To evaluate the role of anticoagulation and other risk factors in thrombus resolution and new thrombus formation.

Main Methods:

• 105 patients with ischemic stroke/TIA underwent transesophageal echocardiography (TEE) at baseline and 9-12 months post-symptom onset.
• TEE assessments focused on thrombi in the left atrium, left atrial appendage, and left ventricle.
• Comparisons were made between patients with and without new or resolved thrombi, analyzing stroke risk factors and anticoagulant use.

Main Results:

• Intracardiac thrombi were initially detected in 18% of patients; 79% of these resolved, significantly correlating with warfarin anticoagulation (p=0.037).
• New thrombi developed in 8% of patients on follow-up TEE, predominantly in older, non-anticoagulated individuals.
• Aortic atheroma ≥4 mm was associated with a higher likelihood of new intracardiac thrombus development (p=0.001).

Conclusions:

• 10-month warfarin anticoagulation appears to promote the disappearance of intracardiac thrombi after cerebral ischemic events, suggesting a therapeutic role.
• Older, non-anticoagulated patients and those with significant aortic atheroma face an increased risk of de novo thrombus development.
• These high-risk patients may benefit from prophylactic anticoagulation to mitigate the risk of cardiac embolization.