scholarly journals Left atrial thrombosis in patients with atrial fibrillation during uninterrupted oral anticoagulation

2021 ◽  
Vol 27 (3) ◽  
pp. 88-98
Author(s):  
Boyan Kunev ◽  
Bilyana Bogdanova ◽  
Pero Popeski ◽  
Tchavdar Shalganov
Keyword(s):  
Oral Anticoagulation ◽  
Left Atrial ◽  
Thromboembolic Event ◽  
Low Dose ◽  
Cardiac Computed Tomography ◽  
Transoesophageal Echocardiography ◽  
Published Data ◽  
Short Term ◽  
Ischemic Attack

Atrial fi brillation (AF) is the most common arrhythmia in adults and requires permanent anticoagulation in the presence of risk factors. Left atrial (LA) thrombus is found in a signifi cant minority of patients despite anticoagulant treatment. We aimed to estimate the prevalence of LA thrombosis on uninterrupted oral anticoagulation (OAC) in AF patients and to determine associated demographic, clinical, echocardiographic and tomographic parameters. Material and methods: We present retrospective study of 702 hospitalizations in 582 patients (397 males, 68.2%) with AF and/or atrial fl utter on uninterrupted OAC for at least 3 weeks, assessed for LA thrombosis with transoesophageal echocardiography and/or cardiac computed tomography. Probability value of p < 0.05 was considered signifi cant for all statistical analyses. Results: The prevalence of LA thrombosis was 6.2%, without signifi cant difference between patients on direct OAC (DOAC) or acenocoumarol (VKA). Non-paroxysmal arrhythmia was signifi cantly associated with LA thrombus, OR 0.369, 95% CI 0.159-0.857, p = 0.02. The proportion of patients on VKA with subtherapeutic INR was signifi cantly higher (30.7%), than the proportion of patients receiving too low dose of DOAC (9.7%), OR 4.1, 95%, CI 2 CI 2.7-6.23, р < 0.001. No association was found between the LA appendage morphology type and the presence of LA thrombus. During a median follow-up of 30 days new stroke/transitory ischemic attack (TIA)/systemic embolism (SE) was registered in seven patients (1.34%), none of them with LA thrombus. Conclusion: The prevalence of LA thrombosis in the studied cohort is comparable to the published data and seemingly had no association with the OAC type. The incidence of stroke/TIA/SE was low on uninterrupted oral anticoagulation during short-term follow-up and there was no association between the presence of LA thrombus and thromboembolic event on follow-up. 

scholarly journals Spontaneously occluded left atrial appendage in a patient with atrial fibrillation and stroke: a case report

2020 ◽  
Vol 4 (2) ◽  
pp. 1-4
Author(s):  
Andreas Bugge Tinggaard ◽  
Kasper Korsholm ◽  
Jesper Møller Jensen ◽  
Jens Erik Nielsen-Kudsk
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Transoesophageal Echocardiography ◽  
Similar Efficacy ◽  
Cardiovascular Death ◽  
Atrial Appendage ◽  
Left Atrial Appendage Occlusion ◽  
All Cause Mortality

Abstract Background  The left atrial appendage (LAA) is the main source of thromboembolism in atrial fibrillation (AF). Transcatheter closure is non-inferior to warfarin therapy in preventing stroke. Case summary  A patient with two consecutive strokes associated with AF was referred for transcatheter LAA occlusion (LAAO). Preprocedural cardiac CT and transoesophageal echocardiography demonstrated a spontaneously occluded LAA with a smooth left atrial surface, with stationary results at 6- and 12-month imaging follow-up. Warfarin was discontinued, and life-long aspirin instigated. Discussion  Left atrial appendage occlusion has shown non-inferiority to warfarin for prevention of stroke, cardiovascular death, and all-cause mortality. No benefits from anticoagulation have been demonstrated in patients with embolic stroke of undetermined source. In the present case, we observed that the LAA was occluded and, therefore, treated with aspirin monotherapy assuming similar efficacy as transcatheter LAAO.

The Ozaki Procedure With CardioCel Patch for Children and Young Adults With Aortic Valve Disease: Preliminary Experience – a Word of Caution

2019 ◽  
Vol 10 (6) ◽  
pp. 724-730 ◽  
Author(s):  
Sian C. Chivers ◽  
Carine Pavy ◽  
Ricky Vaja ◽  
Cesare Quarto ◽  
Olivier Ghez ◽  
...  
Keyword(s):  
Young Adults ◽  
Aortic Valve ◽  
Adult Population ◽  
Published Data ◽  
Bovine Pericardial Patch ◽  
Valve Position ◽  
Children And Young Adults ◽  
Ischemic Attack

Background: The Ozaki procedure is a surgical technique for patients with significant aortic stenosis or regurgitation or both where valve repair cannot be performed. Individual cusps are cut from glutaraldehyde-treated autologous pericardium or bovine pericardium and implanted into the aortic valve position. Encouraging results have been reported within the adult population. There are limited published data on success of this procedure in younger patients. Methods: We present a series of five children and young adults who underwent the Ozaki procedure with neoaortic valve cusps made from CardioCel, a decellularized bovine pericardial patch treated with a monomeric glutaraldehyde. Results: There were no complications in the initial postoperative period and short inpatient stay. At a mean follow-up of 29.6 months (range: 22-36 months), 4 patients had no evidence of stenosis and 3 patients had trivial or no regurgitation from the neoaortic valve. Overall, two patients had complications related to the valve and underwent reintervention during the follow-up period with a Ross procedure. One of these patients who was not taking long-term anticoagulation experienced a transient ischemic attack. Conclusions: Our experience demonstrates that the Ozaki procedure with CardioCel in pediatric and young adult patients should be approached with caution. Further research with larger groups of pediatric patients, comparison of different graft materials, and longer follow-up is required to ascertain long-term success in children.

scholarly journals Anticoagulation Use prior to Common Dental Procedures: A Systematic Review

2019 ◽  
Vol 2019 ◽  
pp. 1-13 ◽  
Author(s):  
Johnny Chahine ◽  
Marwan N. Khoudary ◽  
Samer Nasr
Keyword(s):  
Systematic Review ◽  
Oral Anticoagulation ◽  
Thromboembolic Event ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Novel Oral Anticoagulants ◽  
Thromboembolic Risk ◽  
Dental Procedures ◽  
Number Of Patients

Currently, the number of patients on oral anticoagulation is increasing. There is a paucity of data regarding maintaining oral anticoagulation (especially novel oral anticoagulants) around the time of specific dental procedures. A dentist has three options: either to stop anticoagulation, to continue it, or to bridge with heparin. A systematic review of 10 clinical trials was conducted to address this issue. It was found that continuing anticoagulation during dental procedures did not increase the risk of bleeding in most trials. Although none of the studies reported a thromboembolic event after interruption of anticoagulation, the follow-up periods were short and inconsistent, and the heightened thromboembolic risk when stopping anticoagulation is well known in the literature. Heparin bridging was associated with an increased bleeding incidence. We recommend maintaining oral anticoagulation with vitamin K antagonists and novel oral anticoagulants for the vast majority of dental procedures along with the use of local hemostatic agents.

Long-term implications of left atrial appendage thrombus identified incidentally by pre-procedural cardiac computed tomography angiography in patients undergoing transcatheter aortic valve replacement

2020 ◽  
Author(s):  
Yishay Szekely ◽  
Haim Shmilovich ◽  
Aviram Hochstadt ◽  
Eihab Ghantous ◽  
Yan Topilsky ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Left Atrial ◽  
Transcatheter Aortic Valve Replacement ◽  
Left Atrial Appendage ◽  
Cardiac Computed Tomography ◽  
Cardiac Computed Tomography Angiography ◽  
Late Mortality ◽  
Transcatheter Aortic Valve

Abstract Aims The prevalence and prognostic implications of left atrial appendage (LAA) thrombus (LAAT) in patients considered for transcatheter aortic valve replacement (TAVR) are incompletely defined. We, therefore, studied pre-procedural cardiac computed tomography angiography (CCTA) scans of TAVR candidates to determine the prevalence of LAAT and its association with late outcomes. Methods and results Baseline clinical variables and CCTA findings from a prospective TAVR registry were analysed for the prevalence of pre-procedural LAAT and its impact on in-hospital outcomes and late mortality. LAAT was differentiated from LAA filling defects (LAAFD) reflecting stasis without clot. Patients (n = 561) with complete in-hospital and late mortality data were included in the study (median follow-up 31.6 months). LAAT and LAAFD were evidenced on pre-procedural CCTA in 24 (4.3%) and 26 (4.6%) patients, respectively. One hundred fourteen (20.3%) patients died during the study period. Though in-hospital adverse event rates (including stroke) did not differ among groups, mortality at long-term follow-up was higher among LAAT patients compared with those with or without LAAFD (58.3% vs. 11.5% vs. 19.0%, respectively; P &lt; 0.003). By multivariable analysis, LAAT (but not LAAFD) was independently associated with all-cause mortality [hazard ratio (HR) = 3.33 (1.83–6.00), P &lt; 0.001]. In patients with LAAT, oral anticoagulation at discharge was associated with lower mortality risk, independently of atrial fibrillation status. Conclusions LAAT visualized by pre-procedural CCTA is an independent predictor of late mortality following TAVR, but not peri-procedural stroke. When reporting TAVR-CCTA, particular note should be made of LAA features and presence of LAAT which may have prognostic and management implications.

scholarly journals TCT-689 Left atrial appendage closure with a novel device: initial experience and short-term follow-up from a single center

2017 ◽  
Vol 70 (18) ◽  
pp. B256 ◽  
Author(s):  
Paolo Pagnotta ◽  
Mauro Chiarito ◽  
Elton Pllaha ◽  
Riccardo Mantovani ◽  
Giulio Stefanini ◽  
...  
Keyword(s):  
Left Atrial ◽  
Left Atrial Appendage ◽  
Atrial Appendage ◽  
Initial Experience ◽  
Single Center ◽  
Left Atrial Appendage Closure ◽  
Short Term ◽  
Novel Device

scholarly journals The efficacy of low dose short-term prednisone therapy for remission induction in newly diagnosed rheumatoid arthritis patients

2021 ◽  
Vol 61 (1) ◽  
Author(s):  
John M. Stacy ◽  
Jacob R. Greenmyer ◽  
James R. Beal ◽  
Abe E. Sahmoun ◽  
Erdal Diri
Keyword(s):  
Rheumatoid Arthritis ◽  
Disease Severity ◽  
Low Dose ◽  
Response Criteria ◽  
Newly Diagnosed ◽  
Short Term ◽  
Eular Response ◽  
The Mean ◽  
Dose Prednisone

Abstract Background The ACR/EULAR recommendations endorse the use of glucocorticoids (GCs) for rheumatoid arthritis (RA) patients’ flares and as a bridge to a DMARD. However, the recommendation of low dose short-term monotherapy with (GCs) remains open to the discretion of the clinician. The aim of this study was to assess whether a short-term use of low dose prednisone monotherapy was effective in inducing remission in newly diagnosed RA patients. Methods A retrospective analysis of patients newly diagnosed with RA at a Community Health Center in North Dakota was performed based on the ACR/EULAR RA classification criteria. Demographic and clinical data were abstracted from patients’ medical charts. Patients treated with (< 10 mg/day) of prednisone up to 6 months were included. Response to prednisone was analyzed according to pre- and post-treatment DAS28-ESR score and EULAR response criteria. Results Data on 201 patients were analyzed. The mean prednisone dose was 8 mg/day (range: 5–10; SD = 1.2) and the mean treatment duration was 42.2 days (12–177; 16.9). Disease severity significantly improved from baseline to follow-up for: tender joint count (8.6 ± 4.8 vs. 1.5 ± 3.3; P < 0.001), swollen joint count (6.2 ± 5.0 vs. 1.4 ± 3.0; P < 0.001), and visual analog pain score (4.8 ± 2.6 vs. 2.1 ± 2.5; P < 0.001). DAS28-ESR disease severity significantly improved from baseline to follow-up: (5.1 ± 1.2 vs. 2.7 ± 1.3; P < 0.001). Per EULAR response criteria, 69.7% of patients showed good response to treatment and 20.4% showed moderate response. 54.2% of patients reached remission. Conclusion Short-term use of low dose prednisone monotherapy induced disease remission and improved clinical severity of RA in the majority of newly diagnosed patients.

P765 Does detection of thrombus in left atrial appendage increase risk of ischemic stroke and mortality?

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
E Kagawa ◽  
M Kato ◽  
N Oda ◽  
E Kunita ◽  
M Nagai ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Anticoagulation Therapy ◽  
Transoesophageal Echocardiography ◽  
Atrial Appendage ◽  
Increase Risk ◽  
Baseline Characteristics ◽  
Free Rate

Abstract Background Left atrial appendage (LAA) thrombus is one of causes of cardiogenic stroke and detection of LAA thrombus by transoesophageal echocardiography (TOE) strongly suggest cardiogenic stroke. It was reported that cardiogenic stroke patients had higher in-hospital mortality about 19%; however, little is known about LAA thrombus and mortality after indexed detection of LAA thrombus. We investigated LAA thrombus detection and their prognosis including ischemic stroke and survival. Methods The patients who were performed TOE between 2005 and 2016 in our hospital were enrolled in this study. Patients were divided into 2 groups based on thrombus detection in the LAA, and baseline characteristics and outcomes including prevalence of 5-y stroke-free and survival from the indexed TOE were compared. Results Among the 1260 study patients, the follow-up duration was median 971 d (interquartile range 345 d – 2017 d), and 67% of the patients were performing TOE for atrial fibrillation (AF), 20% for cerebral infarction, and 14% for valvular heart disease. Non-valvular AF was seen in 64% of the study patients and rheumatic AF was in 2%. The age (74 y [66 y – 79 y] vs 70 y [62 y – 76 y], p &lt; 0.001), the prevalence of male sex (67% vs 69%, p = 0.63), and hemoglobin level (13.9 g/dl [12.5 – 15.1 g/dl] vs 13.8 g/dl [12.4 – 14.9 g/dl], p = 0.49) were similar between the patients with LAA thrombus and those without. The CHA2DS2-VASc score (p = 0.008), the prevalence of receiving anticoagulation before TOA (34% vs 24%, p = 0.01), those of after TOA (98% vs 66%, p &lt; 0.001), serum creatinine (0.92 mg/dl [0.80 – 1.10 mg/dl] vs 0.85 mg/dl [0.71 – 1.00 mg/dl], p &lt; 0.001), d-dimer level (1.7 mcg/ml [0.9 – 3.5 mcg/ml] vs 0.8 mcg/ml [0.5 – 2.2 mcg/ml], p &lt; 0.001), and plasma brain natriuretic peptide (315 pg/ml [128 – 515 pg/ml] vs 126 pg/ml [47 – 284 pg/ml], p &lt; 0.001) were higher in the patients with LAA thrombus than those without. The 5-y ischemic stroke-free rate was lower in the patients with LAA thrombus than those without (p &lt; 0.001) (Figure, Panel A); however, the 5-y survival was similar between the 2 groups (p = 0.93) (Panel B). Conclusions The patients who were detected thrombus in the LAA had higher incidence of ischemic stroke, but the survival rate were similar. The higher rate of receiving anticoagulation therapy in the patients with LAA thrombus may be the cause of this discrepancy. Further studies are necessary to clarify this issue. Abstract P765 Figure

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