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The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
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Prevalence and Predictors of Left Atrial Appendage Thrombus by Sex

Radosław Walczewski1, Katarzyna Żelazowska-Chmielińska1, Beata Uziębło-Życzkowska1

  • 1Department of Cardiology and Internal Diseases, Military Institute of Medicine-National Research Institute, Warsaw, Poland.

Clinical and Applied Thrombosis/Hemostasis : Official Journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis
|May 13, 2026
PubMed

Insights

In atrial fibrillation (AF), women have more risk factors but no increased risk of left atrial appendage thrombus (LAAT) compared to men. Sex is not an independent predictor of LAAT, despite clinical differences.

Area of Science:

  • Cardiology
  • Medical Research
  • Clinical Trials

Background:

  • Historically, women with atrial fibrillation (AF) were considered at higher thromboembolic risk than men.
  • The CHA2DS2-VASc score previously treated female sex as an independent risk factor.
  • Current guidelines redefine female sex as a risk modifier within the CHA2DS2-VA score.

Purpose of the Study:

  • To assess the prevalence of left atrial appendage thrombus (LAAT) stratified by sex in patients with AF.
  • To identify independent predictive factors for LAAT, considering sex differences.

Main Methods:

  • Analysis of data from the multicenter, prospective Left Atrial Thrombus on Transesophageal Echocardiography (LATTEE) registry.
  • Inclusion of 3,109 patients diagnosed with AF, all undergoing preprocedural transesophageal echocardiography.
  • Multivariable logistic regression analysis to identify independent predictors of LAAT.

Main Results:

  • Women comprised 36.5% of the study population, presenting with older age, more comorbidities, and higher CHA2DS2-VA scores.
  • The overall prevalence of LAAT was 7.7%, with no significant difference between sexes (8% in women vs. 7.2% in men).
  • In multivariable analysis, factors like paroxysmal AF, smoking, reduced LVEF, DOAC use, and LAAV predicted LAAT in men, while only LAAV remained significant in women. No sex-related effect modification was observed.

Conclusions:

  • Despite a more adverse clinical profile in women with AF, sex was not found to be an independent predictor of LAAT.
  • The study suggests that clinical risk factors, rather than sex itself, are key determinants of LAAT in AF patients.

Keywords:
CHA2DS2-VA scoreleft atrial appendage thrombussex differencethromboembolic riskthrombus predictive factors

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