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[A longitudinal study on left atrial thrombosis in patients with non-rheumatic atrial fibrillation treated with
S Scardi1, C Mazzone, C Pandullo
1Centro Cardiovascolare, Ospedale Maggiore, Trieste.
Insights
Anticoagulant therapy effectively resolves left atrial thrombosis in non-rheumatic atrial fibrillation (NRAF) patients, reducing embolic events but increasing hemorrhage risk. Centralized management is recommended.
Area of Science:
- Cardiology
- Vascular Medicine
- Pharmacology
Background:
- Atrial thrombosis affects 6-27% of non-rheumatic atrial fibrillation (NRAF) patients.
- Limited research exists on the impact of anticoagulant or antiplatelet drugs on atrial thrombosis.
Purpose of the Study:
- To investigate the efficacy of anticoagulant therapy managed by family physicians on left atrial thrombosis in NRAF patients.
- To assess the resolution of left atrial thrombosis using transesophageal echocardiography (TEE) after treatment.
Main Methods:
- Sixty NRAF patients with left atrial/appendage thrombus identified by TEE were enrolled.
- Patients received anticoagulant or antiplatelet therapy; TEE was repeated for follow-up evaluation.
Main Results:
- Thrombosis resolved in 58% of patients overall after a mean 16-month follow-up.
- Effectiveness was observed with both correctly managed anticoagulant therapy (58% resolution) and antiplatelet drugs (57% resolution).
- One embolic event and several hemorrhages were recorded during follow-up.
Conclusions:
- Left atrial thrombosis in NRAF patients significantly resolves with anticoagulant therapy.
- Anticoagulant therapy reduces embolic events but carries a risk of hemorrhage.
- Centralized Anticoagulation Clinics are proposed for improved management of this therapy.
Background:
Although atrial thrombosis is common in patients with non-rheumatic atrial fibrillation (NRAF) (6-27%), there are no studies about the effect that anticoagulant or antiplatelet drugs have on it.
Aim Of The Study:
We have investigated the role of anticoagulant therapy, followed by family physicians, on left atrial thrombosis detected via transesophageal echocardiography (TEE) in patients with NRAF.
Methods:
Sixty patients enrolled in the TASAF (Trieste Area Study on non-rheumatic Atrial Fibrillation) (60% males, mean age 72 +/- 7 years, 17% with lone atrial fibrillation, duration of arrhythmia 111 +/- 79 months), in whom we found a left atrial and/or left atrial appendage thrombus via TEE, were anticoagulated. The thrombus was in the left atrial appendage in 57 patients and in the left atrium in the others. In 28 of them it was mobile and in 50, the left atrial appendage flow was low or absent. Lastly, in 46 patients we found spontaneous echocontrast and a bilobate appendage was present in 8 of them. At follow-up, we repeated the TEE to evaluate the effect of the therapy on the atrial thrombosis.
Results:
Only 53 patients received anticoagulant therapy (45 correctly), while 7 were treated with antiplatelet drugs by their family physicians. After a mean follow-up of 16 months, all patients underwent a repeat TEE and the thrombus was no longer evident in 35 cases (58%). The thrombosis disappeared in 26 (58%) of the 45 patients who correctly took anticoagulant therapy and in 5 of the 8 who were not adequately anticoagulated. Moreover, we didn't observe the thrombus in 4 of the 7 patients who were treated with antiplatelet drugs. There was no significant statistical difference between the benefits of anticoagulants and antiplatelet therapy in dissolving left atrial thrombosis. During follow-up, we recorded only one embolic event in the retina. None of the patients on antiplatelet drugs complained of any side effects, whereas in 5 of the 53 on anticoagulant therapy, we recorded one fatal intracranial hemorrhage, one gastric hemorrhage and three minor complications.
Conclusions:
Left atrial thrombosis in NRAF disappears in anticoagulated patients in an high percentage of cases (the therapy probably acts on more recent thrombi). Moreover, this therapy decreases the incidence of embolic events, although it increases the risk of hemorrages. Since the management of this preventive treatment in general medicine is very difficult, we hope that our health organization will establish Anticoagulation Clinics for the centralized management of this therapy.