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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Role of Early Prothrombotic Evaluation in Device-Related Thrombus Risk Stratification After Left Atrial Appendage
Pedro Cepas-Guillén1, Mathieu Robichaud1, Gilles O Hara1
1Cardiology Department, Quebec Heart & Lung Institute, Laval University, Quebec City, Canada.
Insights
Early prothrombotic status assessment after left atrial appendage closure (LAAC) can identify patients at low risk for device-related thrombus (DRT). This allows for safe exclusion of DRT and potential de-escalation of antithrombotic therapy.
Area of Science:
- Cardiology
- Thrombosis Research
- Medical Device Innovation
Background:
- Left atrial appendage closure (LAAC) is a key strategy for stroke prevention in non-valvular atrial fibrillation patients unsuitable for oral anticoagulation.
- The risk of device-related thrombus (DRT) following LAAC and the utility of early prothrombotic status assessment remain incompletely understood.
Purpose of the Study:
- To investigate the association between early post-LAAC prothrombotic status and the incidence of DRT.
- To identify potential noninvasive markers and thresholds for predicting DRT risk.
Main Methods:
- 147 patients undergoing LAAC without oral anticoagulation were enrolled.
- Coagulation activation markers (prothrombin fragment 1+2, thrombin antithrombin III) were measured at baseline and 7 days post-LAAC.
- Patients were stratified into low or high prothrombotic status based on marker changes; thresholds for DRT prediction were assessed.
Main Results:
- 36.1% of patients had high prothrombotic status; DRT occurred in 6.1% overall, significantly higher in the high-risk group (15.1% vs. 1.1%).
- Elevated post-LAAC coagulation markers independently predicted DRT (aOR 13.84).
- Proposed thresholds for prothrombin fragment 1+2 (74.11%) and thrombin antithrombin III (120.74%) showed 98.9% negative predictive value, identifying 75.5% as low DRT risk.
Conclusions:
- Early coagulation marker evaluation effectively predicts DRT risk post-LAAC.
- The identified thresholds serve as reliable noninvasive tools to rule out DRT.
- These findings may facilitate early antithrombotic de-escalation and reduce imaging needs.
Background:
Left atrial appendage closure (LAAC) is increasingly used for stroke prevention in patients with non-valvular atrial fibrillation and contraindications to oral anticoagulation. The potential role of early prothrombotic status assessment in evaluating device-related thrombus (DRT) risk following LAAC remains unclear.
Methods:
The study included 147 patients undergoing LAAC with oral anticoagulation contraindication. Coagulation activation markers-prothrombin fragment 1 + 2 and thrombin antithrombin III-were measured at baseline and 7 days postprocedure. Based on the 50th percentile of delta (%) changes, patients were classified into low or high prothrombotic status. Specific delta % thresholds were assessed, which could serve as noninvasive cutoffs to rule out DRT.
Results:
A total of 53 patients (36.1%) were classified as having high prothrombotic status. DRT occurred in 9 patients (6.1%), with a significantly higher incidence in the high prothrombotic group (15.1 vs. 1.1%, p < 0.001). Multivariable analysis identified elevated post-LAAC coagulation activation markers as independent predictors of DRT (adjusted odds ratio: 13.84 [1.65-115.89], p = 0.015). Proposed thresholds for prothrombin fragment 1 + 2 (74.11%) and thrombin antithrombin III (120.74%) demonstrated negative predictive values of 98.9%. Using these thresholds, 75.5% of patients were classified as low risk for DRT. No clinical differences were observed at follow-up between the low- and high-risk DRT groups.
Conclusions:
Early evaluation of coagulation markers provides valuable insight into DRT risk after LAAC. The proposed thresholds demonstrate a high negative predictive value, effectively identifying patients at low risk for DRT and supporting their use as noninvasive tools to safely rule out DRT. These markers could enable early antithrombotic de-escalation and reduce the need for repeat imaging. Further studies are warranted.
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