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Published on: February 26, 2013
Predictors of Device-Related Thrombus After Left Atrial Appendage Occlusion: TED-F2 Score
Sania Jiwani1, Ethan Morgan2, Sarah Baghdadi3
1Department of Cardiovascular Medicine, The University of Kansas Medical Center, Kansas City, Kansas.
Insights
A new TED-F2 score helps identify patients at high risk for device-related thrombus after left atrial appendage occlusion. This score aids in preventing stroke by enabling targeted surveillance and anticoagulation strategies.
Area of Science:
- Cardiology
- Medical Devices
- Thrombosis
Background:
- Left atrial appendage occlusion (LAAO) prevents thrombus in atrial fibrillation (AF) patients.
- Device-related thrombus (DRT) occurs in approximately 4% of LAAO procedures.
- Identifying high-risk patients can guide preventative strategies against DRT-related stroke.
Purpose of the Study:
- To develop and validate a risk score for predicting device-related thrombus (DRT) after left atrial appendage occlusion (LAAO).
- To identify key clinical and procedural factors associated with DRT development post-LAAO.
Main Methods:
- Retrospective analysis of patients from the LAAO registry at The University of Kansas Medical Center.
- Comparison of patients with DRT to matched controls without DRT.
- Data extraction from echocardiogram reports and chart reviews, including implant depth measurement.
Main Results:
- A novel TED-F2 score was developed, incorporating venous thromboembolism history, LAA emptying velocity ≤ 20 cm/s, implant depth > 2 cm, and AF rhythm at implantation.
- A TED-F2 score of ≥ 3 was strongly associated with DRT (odds ratio 12.5).
- Specific factors identified as univariate predictors of DRT included prior venous thromboembolism, low LAA emptying velocity, deep implant depth, and AF rhythm during implantation.
Conclusions:
- The proposed TED-F2 risk score effectively identifies patients at significantly elevated risk of developing DRT after LAAO.
- This risk stratification tool can inform clinical decisions regarding patient monitoring and anticoagulation post-LAAO.
- The score comprises easily assessable parameters: venous thromboembolism history, LAA emptying velocity, implant depth, and AF rhythm.
Background:
Left atrial appendage (LAA) occlusion (LAAO) is performed to prevent LAA thrombus in patients with atrial fibrillation (AF). The risk of device-related thrombus (DRT) on the atrial side of the LAAO device is approximately 4%. Identifying patients at high risk of DRT would enable closer surveillance and more-aggressive anticoagulation to prevent post-LAAO DRT-related stroke.
Methods:
From the LAAO registry at The University of Kansas Medical Center, we identified patients who developed DRT. We chose 3 unmatched controls per DRT case from LAAO recipients without DRT. Predictor variables were obtained from transesophageal echocardiogram reports and/or images, transthoracic echocardiogram reports, and chart review. Implant depth was measured from the limbus of the left atrial ridge to the centre of the atrial aspect of the LAAO device, on a 45° transesophageal echocardiogram view.
Results:
We identified 26 patients with DRT (aged 77.7 ± 9.7 years; 34.6% female) and selected 78 unmatched controls without DRT. Univariate predictors of DRT, comprising a novel TED-F2 score, included history of venous Thromboembolism (23.1% vs 5.1%, P = 0.01), an LAA Emptying velocity ≤ 20 cm/s (45.8% vs 18.9%, P = 0.01), an implant Depth > 2 cm (34.6% vs 12.8%, P = 0.02), and presence of AF rhythm at time of device implantation (50.0 % vs 11.5%, P = 0.0001). A TED-F2 score of ≥ 3 was very strongly associated with DRT-odds ratio 12.5 (95% confidence interval, 3.8-41.1, P < 0.0001).
Conclusions:
We propose a novel risk score to predict development of DRT after LAAO, comprising history of venous Thromboembolism, LAA Emptying velocity ≤ 20 cm/s, implant Depth > 2 cm (1 point each), and an AF rhythm at implantation (2 points). A TED-F2 risk score of ≥ 3 identified patients who are at greatly elevated risk of developing DRT.
