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[Left atrial thrombus. Its evolution with oral anticoagulation]
J A Sobrino1, J E Centeno, I Maté
1Unidad Médico Quirúrgica de Cardiología, Hospital La Paz, Facultad de Medicina, Universidad Autónoma, Madrid.
Insights
Patients with left atrial thrombi face a high risk of arterial embolism. However, oral anticoagulation therapy effectively resolves these thrombi in most cases, offering significant therapeutic benefits.
Area of Science:
- Cardiology
- Internal Medicine
Background:
- Left atrial thrombi are a significant concern in patients with atrial fibrillation.
- Associated conditions include mitral valve disease and bioprosthetic valves.
- A history of arterial embolism increases patient risk.
Purpose of the Study:
- To investigate the resolution of left atrial thrombi with oral anticoagulation.
- To assess the risk of arterial embolism in affected patients.
- To evaluate therapeutic implications of anticoagulation.
Main Methods:
- Two-dimensional echocardiography was used for diagnosis.
- Patients received oral anticoagulation with coumadin.
- Follow-up included clinical assessment and echocardiography.
Main Results:
- Left atrial thrombi resolved in 72% of patients and reduced in size in one patient.
- Four patients underwent successful percutaneous mitral valvuloplasty after thrombi resolution.
- One patient experienced a cerebral embolism without lasting effects.
Conclusions:
- Left atrial thrombi are linked to a high risk of arterial embolism.
- Oral anticoagulation is highly effective in resolving left atrial thrombi, indicating its crucial therapeutic role.
Unlabelled:
Left ventricular thrombi were found in 25 patients by two-dimensional echocardiography. All patients were in atrial fibrillation, 16 had mitral or mitroaortic valve diseases and nine mitral or mitroaortic bioprosthetic valves. Nine patients (36%) had history of arterial embolism. At diagnostic time, oral anticoagulation with coumadin was instaured in all the patients. Periodic clinic and echocardiography follow-up was performed. Left atrial thrombi either disappeared (18 patients [72%]) or reduced their size (one patient). Six patients with mitral stenosis were considered as candidates to percutaneous mitral valvuloplasty, which was performed in 4 patients whose thrombi disappeared with anticoagulation therapy in 6 months. During the follow-up one patient had cerebral embolism without sequelae.
Conclusions:
1st. Patients with left atrial thrombi have high risk for arterial embolism. 2nd. Left atrial thrombi disappear in a high proportion after prescribing oral anticoagulation, which has some important therapeutic implications.