Silaruks Songkwan, Thinkhamrop Bandit, Kiatchoosakun Songsak, Wongvipaporn Chaiyasith, Tatsanavivat Pyatat
Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
Ann Intern Med. 2004 Jan 20;140(2):101-5. doi: 10.7326/0003-4819-140-2-200401200-00010.
Resolution of left atrial thrombus after long-term oral anticoagulation enhances safe percutaneous transvenous mitral commissurotomy (PTMC); however, the short-term benefit has not been defined.
To estimate the resolution rate of left atrial thrombus among PTMC candidates after 6 months of oral anticoagulation and to determine its main predictors.
Prospective cohort.
Community-based university medical center.
219 PTMC candidates with thrombus demonstrated by multiplane transesophageal echocardiographic studies.
The primary outcome was the status of the thrombus at the first 6-month follow-up; secondary measures were bleeding or thromboembolic complications.
Among 219 PTMC candidates with left atrial thrombus (mean age [+/-SD], 39.6 +/- 7.4 years [range, 19 to 62 years]), complete resolution of thrombus, with an overall disappearance rate of 24.2% (95% CI, 18.5% to 29.9%), was demonstrated in 53 patients who subsequently underwent successful PTMC. In another 166 patients, the thrombus size was reduced by 24% (P < 0.001). No thrombus resolution was observed in the 27 patients with a left atrial body thrombus. Eighteen patients had minor bleeding. The significant predictors of thrombus resolution were a New York Heart Association class of 2 or less, a left atrial appendage thrombus size of 1.6 cm2 or less, a left atrial spontaneous echocardiographic contrast grade of 1 or less, and an international normalized ratio (INR) of at least 2.5. Patients with all of these predictors had a 94.4% chance of complete thrombus resolution (CI, 84.4% to 98.1%).
After 6 months of oral anticoagulation, the left atrial thrombus disappeared in about a quarter of PTMC candidates so they could safely undergo PTMC. Less clinical severity, lower grading of the left atrial spontaneous echocardiographic contrast, a smaller thrombus, and a higher INR level predict thrombus resolution.
长期口服抗凝治疗后左心房血栓溶解可提高经皮经静脉二尖瓣交界分离术（PTMC）的安全性；然而，其短期获益尚未明确。
评估口服抗凝6个月后PTMC候选患者左心房血栓的溶解率，并确定其主要预测因素。
前瞻性队列研究。
社区大学医学中心。
219例经多平面经食管超声心动图检查证实有血栓的PTMC候选患者。
主要结局为首次6个月随访时血栓状态；次要指标为出血或血栓栓塞并发症。
在219例有左心房血栓的PTMC候选患者（平均年龄[±标准差]，39.6±7.4岁[范围，19至62岁]）中，53例随后成功接受PTMC的患者血栓完全溶解，总体消失率为24.2%（95%可信区间，18.5%至29.9%）。在另外166例患者中，血栓大小缩小了24%（P<0.001）。27例左心房体部血栓患者未观察到血栓溶解。18例患者有轻微出血。血栓溶解的显著预测因素为纽约心脏协会心功能分级为2级或更低、左心耳血栓大小为1.6 cm²或更小、左心房自发超声造影分级为1级或更低以及国际标准化比值（INR）至少为2.5。具有所有这些预测因素的患者血栓完全溶解的概率为94.4%（可信区间，84.4%至98.1%）。
口服抗凝6个月后，约四分之一的PTMC候选患者左心房血栓消失，从而可以安全地接受PTMC。临床严重程度较低、左心房自发超声造影分级较低、血栓较小以及INR水平较高可预测血栓溶解。
