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Prevalence and clinical characteristics associated with left atrial thrombus detection: Apixaban
Hoyle L Whiteside1, Arun Nagabandi2, Kristen Brown3
1Division of Internal Medicine, Medical College of Georgia at Augusta University, Augusta, GA 30912, United States. hwhiteside@augusta.edu.
Insights
Apixaban therapy for atrial fibrillation (AF) patients showed a 3.1% prevalence of left atrial appendage (LAA) thrombus. Persistent AF and reduced LAA velocity are key predictors, indicating TEE may benefit high-risk individuals.
Area of Science:
- Cardiology
- Pharmacology
- Medical Imaging
Background:
- Left atrial appendage (LAA) thrombus prevalence in non-valvular atrial fibrillation (AF) patients on apixaban is not well-defined.
- Identifying risk factors for LAA thrombus can optimize pre-procedural transesophageal echocardiogram (TEE) selection.
Purpose of the Study:
- To determine the prevalence of LAA thrombus detected by TEE in patients with non-valvular AF on continuous apixaban therapy for at least 4 weeks.
- To identify cardiac risk factors and echocardiographic characteristics predicting LAA thrombus formation.
Main Methods:
- Retrospective analysis of 820 patients with AF undergoing TEE.
- Included 226 patients with non-valvular AF on apixaban for ≥ 4 weeks prior to TEE.
- Evaluated clinical and echocardiographic data for LAA thrombus predictors.
Main Results:
- Prevalence of LAA thrombus was 3.1% and LAA thrombus/dense spontaneous echocardiographic contrast was 6.6% after ≥ 4 weeks of apixaban.
- Persistent AF and reduced LAA velocity were independent predictors of LAA thrombus (p=0.0474 and p=0.0489, respectively).
- No thrombi were found in patients with CHA2DS2-VASc score ≤ 1.
Conclusions:
- Apixaban therapy for non-valvular AF patients has a 3.1% LAA thrombus prevalence detected by TEE.
- Continuous apixaban does not eliminate LAA thrombus risk; TEE may benefit patients with multiple risk factors.
- Persistent AF and reduced LAA velocity are significant predictors of LAA thrombus in this population.
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 factors.
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