Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China.
Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China.
Am J Med Sci. 2019 Oct;358(4):273-278. doi: 10.1016/j.amjms.2019.07.013. Epub 2019 Aug 1.
Both warfarin and nonvitamin K antagonist oral anticoagulants (NOACs) are increasingly used for thromboembolic prevention in patients with nonvalvular atrial fibrillation (NVAF). However, there are limited data concerning anticoagulation for left atrial (LA) thrombus or sludge. We aimed to determine the efficacy of warfarin and NOACs in LA thrombus or sludge in patients with NVAF or atrial flutter (AFL).
Seventy-two patients with LA thrombus or sludge were analyzed who were scheduled for catheter ablation of NVAF or AFL between December 2015 and November 2018. Baseline demographics, the nature and duration of anticoagulation therapy and LA thrombus or sludge resolution were recorded.
After receiving anticoagulation therapy for 101.5 (76.3-151) days, 44 patients (61.1%) demonstrated LA thrombus or sludge resolution, including 10 (58.8%) for warfarin, 15 (57.7%) for dabigatran and 19 (65.5%) for rivaroxaban (with no significant differences among these anticoagulants). After either prolonged anticoagulation, increased dosage or a change in anticoagulant, 14 patients underwent a third transesophageal echocardiography after 194.5 days (164.8-401.0) and an additional nine patients (12.5%) demonstrated LA thrombus or sludge resolution. Finally, 53 patients (73.6%) demonstrated complete resolution of LA thrombus or sludge, and this group had a lower CHADS-VASc score (P = 0.044) and a lower rate of stroke history (P = 0.041).
Compared with warfarin, dabigatran and rivaroxaban can also effectively resolve LA thrombus or sludge with no significant differences. Increasing the duration of anticoagulation, determining the optimal dosage of anticoagulants, and switching to another anticoagulant when necessary could be considered to improve treatment effectiveness.
华法林和非维生素 K 拮抗剂口服抗凝剂（NOACs）越来越多地用于预防非瓣膜性心房颤动（NVAF）患者的血栓栓塞。然而，关于左心房（LA）血栓或血栓形成的抗凝治疗数据有限。我们旨在确定华法林和 NOACs 在 NVAF 或心房扑动（AFL）患者的 LA 血栓或血栓形成中的疗效。
分析了 2015 年 12 月至 2018 年 11 月期间计划行 NVAF 或 AFL 导管消融的 72 例 LA 血栓或血栓形成患者。记录了基线人口统计学特征、抗凝治疗的性质和持续时间以及 LA 血栓或血栓形成的消退情况。
在接受抗凝治疗 101.5（76.3-151）天后，44 例（61.1%）患者的 LA 血栓或血栓形成得到缓解，其中华法林 10 例（58.8%），达比加群 15 例（57.7%），利伐沙班 19 例（65.5%），抗凝剂之间无显著差异。在延长抗凝时间、增加剂量或更换抗凝剂后，14 例患者在 194.5 天后（164.8-401.0）再次进行了第三次经食管超声心动图检查，另外 9 例（12.5%）患者的 LA 血栓或血栓形成得到缓解。最终，53 例（73.6%）患者的 LA 血栓或血栓形成完全缓解，这组患者的 CHADS-VASc 评分较低（P=0.044），且卒中史发生率较低（P=0.041）。
与华法林相比，达比加群和利伐沙班也能有效缓解 LA 血栓或血栓形成，且无显著差异。增加抗凝时间、确定抗凝剂的最佳剂量以及必要时更换另一种抗凝剂，可能有助于提高治疗效果。
