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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation

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Oral anticoagulation and left atrial thrombi resolution in nonrheumatic atrial fibrillation or flutter: A systematic

Norman C Wang1, Matthew D Sather1, Aliza Hussain1

  • 1Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.

Pacing and Clinical Electrophysiology : PACE
|May 16, 2018
PubMed

Insights

Warfarin effectively resolves left atrial thrombi (LAT) in nonrheumatic atrial fibrillation (AF) and/or atrial flutter (AFL) with nearly 80% success. More research is needed on direct-acting oral anticoagulants (DOACs) for LAT treatment.

Area of Science:

  • Cardiology
  • Pharmacology

Background:

  • Oral anticoagulation (OAC) is standard for left atrial thrombi (LAT) in nonrheumatic atrial fibrillation (AF) and/or atrial flutter (AFL).
  • Evidence on LAT resolution rates with various OAC agents requires synthesis.

Purpose of the Study:

  • To review existing evidence on the resolution of LAT in nonrheumatic AF/AFL using OAC agents.
  • To evaluate pooled LAT resolution rates for different OAC classes.

Main Methods:

  • Systematic review of PubMed, EMBASE, and CENTRAL databases (1991-2017).
  • Inclusion of English-language studies using serial transesophageal echocardiography for LAT assessment with follow-up ≥ 3 weeks and < 1 year.
  • Quality assessment and pooled analysis of resolution rates for Vitamin K Antagonists (VKAs) and specific warfarin studies.

Main Results:

  • Pooled LAT resolution rate for 619 subjects on VKAs was 63.7%.
  • For 94 subjects on warfarin with specific INR criteria, the pooled LAT resolution rate was 79.3%.
  • Direct-acting oral anticoagulants (DOACs) showed varied results: 89.5% for dabigatran and 41.5% for rivaroxaban.

Conclusions:

  • Warfarin demonstrates a high LAT resolution rate (nearly 80%) and is the most studied initial OAC agent.
  • Further research into the efficacy of DOACs for LAT resolution is warranted.
Abstract

Keywords:
atrial fibrillationatrial flutterleft atrial thrombioral anticoagulation

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