Department of Cardiology, West-German Heart Center Essen, University Hospital Essen, University Duisburg-Essen, Essen, Germany.
JACC Cardiovasc Interv. 2013 Jun;6(6):606-13. doi: 10.1016/j.jcin.2013.02.014.
This study sought to identify risk factors for thrombus formation on the Amplatzer Cardiac Plug (ACP) (St. Jude Medical, St. Paul, Minnesota) after left atrial appendage occlusion.
Left atrial appendage occlusion with the ACP aims to reduce the risk of embolic stroke and bleeding complications associated with vitamin K antagonists in patients with atrial fibrillation.
We performed transesophageal echocardiography before discharge and after 3, 6, and 12 months in 34 patients with atrial fibrillation undergoing ACP implantation and receiving dual antiplatelet therapy. Clinical, echocardiographic, and hemostaseological parameters were retrospectively analyzed to identify risk factors for thrombus formation.
Three patients had thrombi before discharge, 3 more at the 3-month follow-up. No differences were found in left atrial volume, left atrial appendage velocity, spontaneous echo contrast, transmitral gradient, or mitral regurgitation between patients without or with thrombi. CHADS2 (Congestion, Hypertension, Age, Diabetes, and Stroke) score (2.0 ± 1.1 vs. 4.3 ± 1.0), CHA2DS2-VASc (CHADS2 plus Vascular Disease and Sex Category) score (5.2 ± 1.3 vs. 6.8 ± 0.8), and pre-interventional platelet count (215.9 ± 63.9/nl vs. 282.5 ± 84.4/nl) were higher and ejection fraction (50.6 ± 11.4% vs. 39.7 ± 10.6%) lower in those with thrombi. Factor 2, factor 5, or methylenetetrahydrofolate reductase mutations and genetic variants associated with reduced clopidogrel activity were not more frequent in patients with thrombi.
Transesophageal echocardiography identified 17.6% of patients with thrombus formation on the ACP despite dual antiplatelet therapy. CHADS2 and CHA2DS2-VASc scores, platelet count, and ejection fraction are risk factors for such thrombus formation.
本研究旨在确定左心耳封堵（ACP）术后血栓形成的危险因素。
使用 ACP 进行左心耳封堵旨在降低房颤患者使用维生素 K 拮抗剂相关的栓塞性中风和出血并发症的风险。
我们对 34 例行 ACP 植入术并接受双联抗血小板治疗的房颤患者在出院前、术后 3、6 和 12 个月进行经食管超声心动图检查。回顾性分析临床、超声心动图和止血学参数，以确定血栓形成的危险因素。
3 名患者在出院前发生血栓，3 名患者在术后 3 个月时发生血栓。无血栓患者与有血栓患者的左心房容积、左心耳速度、自发性回声对比、二尖瓣跨瓣梯度或二尖瓣反流无差异。CHADS2（充血、高血压、年龄、糖尿病和中风）评分（2.0±1.1 与 4.3±1.0）、CHA2DS2-VASc（CHADS2 加血管疾病和性别类别）评分（5.2±1.3 与 6.8±0.8）和术前血小板计数（215.9±63.9/nl 与 282.5±84.4/nl）较高，射血分数（50.6±11.4%与 39.7±10.6%）较低。血栓形成患者中，因子 2、因子 5 或亚甲基四氢叶酸还原酶突变以及与氯吡格雷活性降低相关的遗传变异并不更常见。
尽管进行了双联抗血小板治疗，但经食管超声心动图仍发现 17.6%的 ACP 患者存在血栓形成。CHADS2 和 CHA2DS2-VASc 评分、血小板计数和射血分数是血栓形成的危险因素。
