Med. Klinik Und Poliklinik II, Herzzentrum Bonn, Universitätsklinikum Bonn, Bonn, Germany.
Elisabeth Krankenhaus, Essen, Germany.
Clin Res Cardiol. 2021 Jan;110(1):72-83. doi: 10.1007/s00392-020-01651-8. Epub 2020 Apr 19.
Data on thrombus resolution and clinical outcome data after a therapy of LAA thrombus with novel oral anticoagulants (NOACs) are scarce.
In this single-center study, we retrospectively analyzed 78 patients diagnosed with a solid LAA thrombus by transesophageal echocardiography (TEE). We assessed baseline clinical and echocardiographic characteristics, the anticoagulatory regimens and outcomes of patients with (responders) and without (non-responders) thrombus resolution.
Mean age was 76.1 ± 8.3 years, patients were male in 57.7% and presented with a high risk for thromboembolism (CHADS-VASc: 4.3 ± 1.1). At thrombus diagnosis, 44.9% patients were treated with a NOAC, while 41.0% were under therapy with a VKA. Complete thrombus resolution was achieved after a mean of 116 ± 79 days in a total of 51.3% of patients, 35.9% showed a reduction of thrombus size, whereas 12.8% showed no changes in thrombus dimensions. There was no statistically significant difference in the rate of LAA thrombus resolution between VKA and NOACs (41.2 vs. 57.1%, p = 0.18). However, in cases in which only the therapy with a NOAC led to complete thrombus resolution, the time needed was significantly shorter than with VKA (81 ± 38 vs. 129 ± 46 days, p = 0.03). Regarding safety outcomes, no differences in bleeding or thromboembolism were observed between patients with and without thrombus resolution.
In this registry, approximately 85% of LAA thrombi were diagnosed in patients with ongoing OAC. Thrombus resolution was observed in nearly 50% of cases. Although there was no difference in the rate of LAA thrombus resolution between VKA and NOACs, the resolution time was shorter in patients prescribed a NOAC.
新型口服抗凝剂（NOACs）治疗左心耳（LAA）血栓后的血栓溶解和临床结局数据稀缺。
在这项单中心研究中，我们回顾性分析了 78 例经食管超声心动图（TEE）诊断为 LAA 实性血栓的患者。我们评估了基线临床和超声心动图特征、抗凝方案以及血栓溶解的患者（应答者）和未溶解的患者（非应答者）的结局。
平均年龄为 76.1±8.3 岁，57.7%的患者为男性，存在高血栓栓塞风险（CHADS-VASc：4.3±1.1）。在血栓诊断时，44.9%的患者接受了 NOAC 治疗，而 41.0%的患者接受了 VKA 治疗。共有 51.3%的患者在平均 116±79 天内完全溶解血栓，35.9%的患者血栓大小减小，12.8%的患者血栓大小无变化。VKA 和 NOAC 治疗组 LAA 血栓溶解率无统计学差异（41.2% vs. 57.1%，p=0.18）。然而，仅用 NOAC 治疗即可完全溶解血栓的患者所需时间明显短于 VKA 治疗（81±38 天 vs. 129±46 天，p=0.03）。关于安全性结局，血栓溶解和未溶解的患者在出血或血栓栓塞方面无差异。
在本研究中，约 85%的 LAA 血栓在持续 OAC 的患者中被诊断。近 50%的病例观察到血栓溶解。虽然 VKA 和 NOAC 治疗组的 LAA 血栓溶解率无差异，但服用 NOAC 的患者的溶解时间更短。
