scholarly journals Successful Resolution of a Large Left Atrial and Left Atrial Appendage Thrombus with Rivaroxaban

2019 ◽  
Vol 2019 ◽  
pp. 1-4 ◽  
Author(s):  
Safwan Gaznabi ◽  
Ashraf Abugroun ◽  
Hasan Mahbub ◽  
Enrique Campos
Keyword(s):  
Left Atrial ◽  
Left Atrial Appendage ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Atrial Appendage ◽  
Limited Data ◽  
Successful Resolution ◽  
History Of ◽  
Improve Treatment Efficacy

A 79-year-old male was admitted to the hospital for acute exacerbation of heart failure. The patient had history of atrial fibrillation and was planned for cardioversion. Preprocedure transesophageal echocardiogram (TEE) revealed a large multilobulated mobile thrombus in the left atrial appendage. The patient refused warfarin therapy and instead chose to take rivaroxaban. Upon outpatient follow-up, 3 months later, no visible thrombus was appreciated on repeat TEE. This case demonstrates successful resolution of left atrial and left atrial appendage thrombi with the use of rivaroxaban. At present time, limited data is available to support the use of rivaroxaban for treatment of intracardiac thrombi. This case highlights the need for further studies to investigate the outcomes and relative efficiency of use of direct oral anticoagulants (DOACs) in lysis of intracardiac thrombus. The benefits of DOACs compared to the standard of therapy could increase patient compliance, reduce length of stay, and improve treatment efficacy.

scholarly journals Left Atrial Appendage Thrombus Prior to Atrial Fibrillation Ablation in the Era of Direct Oral Anticoagulants

2018 ◽  
Vol 82 (11) ◽  
pp. 2715-2721 ◽  
Author(s):  
Masahide Harada ◽  
Masayuki Koshikawa ◽  
Yuji Motoike ◽  
Tomohide Ichikawa ◽  
Kunihiko Sugimoto ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Atrial Fibrillation Ablation ◽  
Atrial Appendage ◽  
Left Atrial Appendage Thrombus

scholarly journals Prevalence and Resolution of Resistant Left Atrial Appendage Thrombus in Non-Valvular Atrial Fibrillation Patients Submitted to Percutaneous Interventions

2021 ◽  
Vol 4 (8) ◽  
pp. 01-09
Author(s):  
Fabricio Vassallo
Keyword(s):  
Atrial Fibrillation ◽  
Mechanism Of Action ◽  
Complete Resolution ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Atrial Appendage ◽  
Antiplatelet Drug ◽  
Diabetes Diagnosis

Introduction: Left atrial appendage (LAA) thrombus in atrial tachyarrhythmias is one of the principal causes of stroke. Prevalence and strategies to thrombus resolution has recently been described in the era of the direct oral anticoagulants (DOAC). The aim of the study was to determine the prevalence and strategies to resolve previous LAA thrombus during regular oral antithrombotic therapy in preparation to perform atrial fibrillation (AF) ablation and/or LAA closure. Methods: Between January 2011 and December 2020 we prospectively followed 23 patients (5.39%) that showed LAA thrombus formation. Persistent AF occurred in 13 (56.52%), median age 72.39 years, 15 (65.22%) females, median CHA2DS2VASC of 4.13, HASBLED of 2.28, 17 (73.91%) with hypertension, (52.17%) with coronary disease, 9 (39.13%) had priors’ thromboembolic events, 7 (30.43%) with heart failure and Diabetes. Diagnosis was by transesophageal echocardiogram (TEE) in 20 (86.96%) and the rest by computed angiotomography. Rivaroxaban was used in 11 (47.83%), Dabigatran in 6 (26.09%), 5 (21.74%) with therapeutic range Warfarin and 1 (4.34%) with Apixaban. Main strategy of treatment was to change mechanism of action of antithrombotic medication in association to an antiplatelet drug, Clopidogrel 75mg a day, and perform a TEE at 90 days after. Results: Complete resolution of the LAA thrombus was achieved in 18 (78.26%) patients in first medical therapeutic change. Of the remaining a second approach with medical therapy adjustment with off-label dose prescription associated with Clopidogrel showed complete resolution in 3 (13.04%) totalizing a success rate of 91.30% for all patients (p value of 0.001 for treatment success). The failure of the antithrombotic plus antiplatelet therapy occurred in 2 (8.7%) patients, one with LAA sludge and other with a huge thrombus in all LAA and part of left atrium. Conclusion: Modification of the mechanism of action of direct oral anticoagulants in association with Clopidogrel demonstrates to be successful in a large number of patients with previous resistant left atrial thrombus with and secure since the low adverse event rates.

Efficiency of the Left Atrial Appendage Thrombus Dissolution in Patients with Persistent Nonvalvular Atrial Fibrillation with Warfarin or Direct Oral Anticoagulants Therapy

2021 ◽  
Vol 17 (5) ◽  
pp. 724-728
Author(s):  
E. S. Mazur ◽  
V. V. Mazur ◽  
N. D. Bazhenov ◽  
Yu. A. Orlov
Keyword(s):  
Atrial Fibrillation ◽  
Regression Analysis ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Atrial Appendage ◽  
Nonvalvular Atrial Fibrillation ◽  
Left Atrial Appendage Thrombus ◽  
Echocardiographic Examination

Aim. Compare the incidence of the left atrial appendage (LAA) thrombus dissolution in patients with persistent nonvalvular atrial fibrillation receiving warfarin and direct oral anticoagulants (DOAC).Materials and methods. 68 patients with persistent nonvalvular atrial fibrillation were included in a retrospective study (age was 59.7±9.8 years, 60.3% men), in whom at least one repeated transesophageal echocardiographic examination was performed after detecting a thrombus. After detecting a thrombus in the LAA, 37 (54.4%) patients started or continued taking warfarin in doses that ensure the INR maintenance at the level of 2-3, 14 (20.6%) started or continued taking dabigatran at a dose of 150 mg 2 times/day, 14 (20.6%) started or continued taking rivaroxaban 20 mg 1 time/day and 3 (4.4%) started or continued taking apixaban 5 mg 2 times/day. Repeated transesophageal echocardiographic examination was performed on average 33.3±14.2 days after the first one.Results. Dissolution of a previously identified thrombus was found in 26 (83.9%) of 31 patients receiving DOAC and in 19 (51.4%) of 37 patients receiving warfarin (p=0.011). The logistic regression analysis showed that the chances of a thrombus dissolution in LAA while taking DOAC are 14.8 times (95% confidence interval [CI] was 2.469-88.72) higher than while taking warfarin. The size and the rate at which blood is expelled from the LAA also have an independent influence on the chances of thrombus dissolution. An increase in the size of a thrombus by 1 mm reduces the chances of a thrombus dissolution by 1.136 (95% CI was 1.040-1.244) times, and an increase in the rate of blood expulsion from the LAA by 1 cm/sec increases these chances by 1.105 (95% CI was 1.003-1.219) times.Conclusion. In the present study, the incidence of the LAA thrombus dissolution in patients with persistent nonvalvular atrial fibrillation while receiving DOAC was higher than while receiving warfarin.

Stand-Alone Thoracoscopic Left Atrial Appendage Closure in Nonvalvular Atrial Fibrillation Patients at High Bleeding Risk

2020 ◽  
Vol 15 (6) ◽  
pp. 541-546
Author(s):  
Marco Franciulli ◽  
Giuseppe De Martino ◽  
Mariateresa Librera ◽  
Ahmed Desoky ◽  
Antonio Mariniello ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Oral Anticoagulants ◽  
Bleeding Risk ◽  
Atrial Appendage ◽  
Nonvalvular Atrial Fibrillation ◽  
High Bleeding Risk ◽  
Laa Closure

Objective In nonvalvular atrial fibrillation (AF) patients at high bleeding risk, oral anticoagulants (OAC) may be contraindicated, and percutaneous left atrial appendage (LAA) closure has been advocated. However, following percutaneous procedure, either OAC or dual antiplatelet treatment is required. In this study, we present our experience in treating nonvalvular AF patients at high bleeding risk with thoracoscopic LAA closure with no subsequent antithrombotic therapy. Methods From April 2019 to January 2020, 20 consecutive AF patients, mean age 75.1 years, 16 (80%) males, underwent thoracoscopic LAA closure as a stand-alone procedure, using an epicardial clip device. OAC and antiplatelet therapy were contraindicated. Mean CHA2DS2-VASc score was 3.61, and the mean HAS-BLED score was 4.42. Successful LAA closure was assessed by transesophageal echocardiography. Primary endpoints were complete LAA closure (no residual LAA flow), operative complications, and all-cause mortality; secondary endpoints were 30-day and 6-month complications (death, ischemic stroke, hemorrhagic stroke, transient ischemic attack, any bleeding). Mean follow-up was 6 ± 4 months. Results Complete LAA closure was achieved in all patients. No operative clip-related complications or deaths occurred. At follow-up, freedom from postoperative complications was 95% and from any cerebrovascular events was 100%. Overall survival rate was 100%. Conclusions In nonvalvular AF patients at high bleeding risk (HAS-BLED score >3), thoracoscopic LAA closure appears to be a valid alternative to percutaneous techniques not requiring dual antiplatelet or OAC treatment. Apparently, external LAA clipping minimizes the risk of thromboembolic events as compared with percutaneous procedures.

scholarly journals Antithrombotic Dilemmas after Left Atrial Appendage Occlusion Watchman Device Placement

2019 ◽  
Vol 2019 ◽  
pp. 1-3 ◽  
Author(s):  
Tania Ahuja ◽  
Scarlett Murphy ◽  
Daniel J. Sartori
Keyword(s):  
Antithrombotic Therapy ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Atrial Appendage ◽  
Left Atrial Appendage Occlusion ◽  
Device Implantation ◽  
Watchman Device ◽  
Device Placement

Antithrombotic therapy for stroke prevention in patients with atrial fibrillation (AF) has dramatically shifted from warfarin, a vitamin K antagonist, to the direct oral anticoagulants (DOACs) such as dabigatran, apixaban, and rivaroxaban. In patients with contraindications to oral anticoagulation, left atrial appendage occlusion (LAAO) devices, such as the Watchman™ device, may be considered; however, temporary postimplantation antithrombotic therapy is still a recommended practice. We present a case of complex antithrombotic management, post LAAO device implantation, designed to avoid drug interactions with concomitant rifampin use and remained necessary secondary to subsequent device leak. This case highlights the challenges of antithrombotic therapy post LAAO device placement in a complex, but representative, patient.

scholarly journals Is warfarin associated with higher risk of thrombus in left atrial appendage than direct oral anticoagulants?

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
E Kagawa ◽  
M Kato ◽  
N Oda ◽  
E Kunita ◽  
M Nagai ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Previous History ◽  
Anticoagulation Therapy ◽  
The Body ◽  
Atrial Appendage ◽  
Warfarin Group

Abstract Funding Acknowledgements Type of funding sources: None. Background Thrombus in left atrial appendage (LAA) is associated with cardiogenic ischemic stroke, and anticoagulation therapy is utilized to prevent thromboembolism. Purpose This study is to investigate the incidence of thrombus in left atrial appendage detected by transoesophageal echocardiography (TOE) under anticoagulation therapy with warfarin or direct oral anticoagulants (DOAC). Methods Between 2005 and 2016, the patients who underwent TOE under anticoagulation therapy due to atrial fibrillation more than one month were enrolled in this study. The patients were divided into 2 groups according to whether treated with warfarin or DOAC and baseline characteristics and incidence of LAA thrombus were assessed. Results Among the 313 study patients, 243 (78%) were treated with warfarin. The patients treated with warfarin were elder (median 73 y vs. 67 y [interquartile range 66 – 78 y vs. 58 – 72 y], P < 0.01), the body mass index was lower (23.2 vs. 24.0 [21.0 – 25.4 vs. 21.3 – 26.9], P = 0.03). The prevalence of male sex (64% vs. 71%, P = 0.26) were similar between the 2 groups. The previous history of hypertension (69% vs. 59%, P = 0.10), diabetes (24% vs. 19%, P = 0.32), vascular disease (30% vs. 26%, P = 0.52), and ischemic stroke were similar between the 2 groups (30% vs. 23%, P = 0.22). The prevalence of CHA2DS2-VASc score > 1 (84% vs. 59%, P < 0.01) and the d-dimer level (0.7 vs. 0.5 mcg/ml [0.5 – 1.8 vs. 0.5 – 0.5 mcg/ml], P < 0.01) were higher in the warfarin groups than those of the DOAC. The velocity of LAA was slower in the warfarin group than those of DOAC (35 vs. 55 cm/s [21 – 54 vs. 38 – 68 cm/s], P < 0.01). The incidence of detection of LAA thrombus was 19% in the warfarin group and 3% in the DOAC group (P < 0.01). In the warfarin group, the PT-INR were lower in the patients with LAA thrombus (1.38 vs. 1.66 [1.11 – 1.92 vs. 1.34 – 2.03], P = 0.03). Conclusions The higher risk of ischemic stroke and out of range PT-INR may be the cause of the higher incidence of LAA thrombus in the patients treated with warfarin than those with DOAC. Abstract Figure.

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