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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
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Left Atrial Appendage Thrombosis and Oral Anticoagulants: A Meta-Analysis of Risk and Treatment Response

Yun-Yung Cheng1, Shennie Tan1, Chien-Tai Hong1,2

  • 1Department of Neurology, Shuang-Ho Hospital, Taipei Medical University, New Taipei 235, Taiwan.

Journal of Cardiovascular Development and Disease
|October 26, 2022
PubMed

Insights

Direct oral anticoagulants (DOACs) are more effective than vitamin K antagonists (VKAs) in reducing left atrial appendage thrombus (LAAT) incidence and promoting LAAT resolution in patients with atrial fibrillation (AF). DOACs represent a preferable anticoagulation choice.

Area of Science:

  • Cardiology
  • Pharmacology
  • Evidence-based Medicine

Background:

  • Left atrial appendage thrombus (LAAT) is a primary cause of cardioembolism in nonvalvular atrial fibrillation (AF) patients.
  • Current guidelines recommend vitamin K antagonists (VKAs) for LAAT treatment, despite emerging evidence favoring direct oral anticoagulants (DOACs).
  • This meta-analysis aims to compare the efficacy of DOACs versus VKAs in managing LAAT.

Purpose of the Study:

  • To compare the effectiveness of DOACs and VKAs in treating left atrial appendage thrombus (LAAT).
  • To evaluate the incidence of LAAT under DOAC versus VKA treatment.
  • To assess the resolution rates of LAAT with DOAC versus VKA therapy.

Main Methods:

  • A comprehensive meta-analysis was performed using studies from PubMed, Embase, Google Scholar, and Cochrane Library databases.
  • Literature search was conducted up to July 2022, restricted to English-language publications.
  • Two analyses were performed: one for LAAT incidence and another for LAAT resolution comparing DOACs and VKAs.

Main Results:

  • DOAC treatment showed a significant reduction in LAAT incidence compared to VKA (pooled RR = 0.65, 95% CI = 0.47-0.90, p = 0.009).
  • DOACs demonstrated a significantly higher probability of LAAT resolution than VKAs (pooled odds ratio = 1.52, 95% CI = 1.02-2.26, p = 0.040).
  • Moderate heterogeneity was observed across the pooled studies.

Conclusions:

  • DOACs are superior to VKAs in reducing LAAT incidence and increasing the likelihood of LAAT resolution in AF patients.
  • DOACs offer a preferable anticoagulation option due to their established safety profile.
  • Further randomized controlled trials are necessary to solidify DOACs as a recommended treatment for LAAT.

Keywords:
atrial fibrillationleft atrial appendage thrombusoral anticoagulantstroke

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