scholarly journals Evidence-Based Case Report: The Use of D-Dimer Assay to Exclude Left Atrial Thrombus in Patient with Atrial Fibrillation >48 Hours

2019 ◽  
Vol 11 (6) ◽  
Author(s):  
Raymond Pranata ◽  
Emir Yonas ◽  
Veresa Chintya ◽  
Alexander Edo Tondas ◽  
Sunu Budhi Raharjo
Keyword(s):  
Atrial Fibrillation ◽  
Case Report ◽  
Left Atrial ◽  
Evidence Based ◽  
Left Atrial Thrombus ◽  
Atrial Thrombus ◽  
D Dimer

scholarly journals Diagnostic accuracy of D-dimer to detect left atrial thrombus in patients with atrial fibrillation: a systematic review and meta-analysis

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
C Diaz-Arocutipa ◽  
A.C Gonzales-Luna ◽  
A Branez-Condorena ◽  
A.V Hernandez
Keyword(s):  
Atrial Fibrillation ◽  
Diagnostic Accuracy ◽  
Left Atrial ◽  
Meta Analysis ◽  
Characteristic Curve ◽  
Left Atrial Thrombus ◽  
Summary Receiver Operating Characteristic ◽  
Atrial Thrombus ◽  
Cross Sectional ◽  
D Dimer

Abstract Background There is limited evidence on the use of biomarkers to diagnose left atrial thrombus in atrial fibrillation. Purpose We evaluated the diagnostic accuracy of D-dimer to detect left atrial thrombus in patients with atrial fibrillation. Methods We searched four electronic databases from inception to December 16, 2020 for observational studies evaluating diagnostic accuracy of D-dimer. Reference standard was left atrial thrombus detected by transesophageal echocardiography. Study quality was assessed with the QUADAS-2 tool. We performed a bivariate random-effects meta-analysis to calculate the pooled sensitivity and specificity with their 95% confidence intervals (95% CI). In addition, a summary receiver operating characteristic curve and optimal cut-off were estimated. Results Eleven cross-sectional studies involving 4380 patients were included. The mean age ranged from 49.8 to 74.1 years and 70% of patients were men. Left atrial thrombus was present in 7% of cases. In seven studies, the pooled sensitivity of D-dimer at 500 ng/mL was 53% (95% CI, 26–79%) and the pooled specificity was 92% (95% CI, 80–97%). The pooled sensitivity of age-adjusted D-dimer was 35% (95% CI, 18–57%) and the pooled specificity was 100% (95% CI, 100–100%) in two studies. The optimal cut-off was 390 ng/mL in 10 studies with a pooled sensitivity of 68% (95% CI, 44–85%) and a pooled specificity of 73% (95% CI, 54–86%). The risk of bias was low or unclear for all domains. Concerns regarding applicability were generally low for almost all studies Conclusion Our meta-analysis suggests that D-dimer has the potential to be useful to the detection of left atrial thrombus in patients with atrial fibrillation. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals Left Atrial Thrombus Resolution Using Unfractionated Heparin and Warfarin in a Patient with Mitral Stenosis

2019 ◽  
Vol 40 (3) ◽  
Author(s):  
Zainuddin Zainuddin ◽  
Endang Ratnaningsiah ◽  
Andika Rizki Lubis ◽  
Sebastian Andi Manurung ◽  
Tike Hari Pratikto ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Case Report ◽  
Unfractionated Heparin ◽  
Mitral Stenosis ◽  
Left Atrial ◽  
Oral Anticoagulant Therapy ◽  
Neurological Deficits ◽  
Left Atrial Thrombus ◽  
Atrial Thrombus ◽  
Diastolic Phase

Abstract Background:  Though the use of Low Molecular Weight Heparin (LMWH) in general is preferred due to its convenient and eliminates the need for activated Partial Thromboplastin Time ( aPTT) monitoring but Unfractionated Heparin (UFH) is still widely used in clinical setting due to its availability and low price. Besides UFH, the use of oral anticoagulant therapy with warfarin, has been the standard therapy for the prevention of thromboembolism in patients with AF. Our aim is to report a case of the resolution of left atrial thrombus in a patient with mitral stenosis. Case Illustration:  A Case report of a female patient aged 54 years who admitted with a sudden neurological deficits and mitral stenosis with atrial fibrillation.  Transthoracal Echocardiography (TTE) showed mobile thrombus which moved and obstructed the mitral valve during diastolic phase. Unfractionated heparin (UFH) was administered 3000 unit bolus intravenously and maintained with 600 unit per hour with the combination of warfarin 2 mg for five days. TTE evaluation showed the resolution of LA thrombus.  Conclusion : The administration of the combination of UFH and warfarin had successfully caused  resolution of  the LA thrombus and prevented the patient from surgical intervention. This case report indicated that Unfractionated Heparin and Warfarin were still the treatments option in LA thrombus patients with mitral stenosis and atrial fibrillation.   Key words :Left atrial thrombus, unfractionated heparin, thrombus resolution    

scholarly journals Large left atrial thrombus in a patient in sinus rhythm without mitral valve disease: A case report

2021 ◽  
Author(s):  
Hironobu Nishiori ◽  
Hiroyuki Watanabe ◽  
Yuichi Hirano ◽  
Masayoshi Otsu
Keyword(s):  
Atrial Fibrillation ◽  
Case Report ◽  
Mitral Valve ◽  
Mitral Valve Disease ◽  
Left Atrial ◽  
Atrial Septum ◽  
Valve Disease ◽  
Left Atrial Thrombus ◽  
Atrial Thrombus ◽  
History Of

We report a case of a 63-year-old man without a history of atrial fibrillation or mitral valve disease who was admitted to our hospital. Echocardiography revealed a large left atrial mass attached to the atrial septum. We suspected the mass to be a myxoma, but it turned out to be a large thrombus after the surgery. Left atrial thrombus without mitral valve disease or atrial fibrillation is rare. Although the degree of urgency varies based on the case, early surgical resection is recommended for a large left atrial thrombus to prevent embolism.

D-dimer blood concentrations to exclude left atrial thrombus in patients with atrial fibrillation

Heart ◽  
2020 ◽  
pp. heartjnl-2020-317612
Author(s):  
Alexandre Almorad ◽  
Anush Ohanyan ◽  
Georgiana Pintea Bentea ◽  
Jean-yves Wielandts ◽  
Milad El Haddad ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
False Negative ◽  
Transoesophageal Echocardiography ◽  
Elisa Test ◽  
Left Atrial Thrombus ◽  
Atrial Thrombus ◽  
True Negative ◽  
Blood Concentrations ◽  
D Dimer

ObjectiveLeft atrial (LA) thrombus is routinely excluded by transoesophageal echocardiography (TOE) before cardioversion for non-valvular atrial fibrillation (AF). In the D-dimer blood concentrations to exclude LA thrombus in patients with AF study, two D-dimer cut-offs were compared to exclude LA thrombus prior to cardioversion. One was fixed to 500 ng/mL (DD500), based on clinical practice where such values are commonly accepted to exclude a thrombus. The other cut-off was adjusted to 10 times the patient’s age (DDAge), based on the cut-off used to exclude pulmonary embolism.Methods142 consecutive patients with non-valvular AF aged 69.7±11.4 years (52% with paroxysmal AF) referred for precardioversion TOE to exclude LA thrombus were prospectively enrolled. D-dimers were measured at the time of TOE by an ELISA test.ResultsLA thrombus was excluded with TOE in 129 (91%) and confirmed in 13 (9%) patients. D-dimers were significantly lower in patients without LA thrombus (729±611 vs 2376±1081 ng/L; p<0.05). DDAge indicated absence of LA thrombus with higher specificity than DD500 (66.4% vs 50.4%; p<0.05). Both cut-offs were able to identify all 13 patients with LA thrombus (false negative 0%). Patients with D-dimers <DDAge and without LA thrombus (true negative) represented 60.6% of the population and could have safely avoided TOE (flow chart).ConclusionsThis study demonstrates the efficacy of D-dimer cut-offs to exclude LA thrombus in patients with AF. Age adjustment greatly increases the proportion of patients in whom LA thrombus can be safely excluded and consequently avoid precardioversion TOE.

scholarly journals Stroke or left atrial thrombus prediction using antithrombin III and mean platelet volume in patients with nonvalvular atrial fibrillation

2017 ◽  
Vol 40 (11) ◽  
pp. 1013-1019 ◽  
Author(s):  
Seo-Won Choi ◽  
Bo-Bae Kim ◽  
Dong-Hyun Choi ◽  
Geon Park ◽  
Byung Chul Shin ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Mean Platelet Volume ◽  
Left Atrial ◽  
Antithrombin Iii ◽  
Left Atrial Thrombus ◽  
Platelet Volume ◽  
Nonvalvular Atrial Fibrillation ◽  
Atrial Thrombus
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