II Department of Heart Arrhythmia, National Institute of Cardiology, Alpejska 42, 04-628, Warsaw, Poland.
Department of Coronary Artery Disease and Cardiac Rehabilitation, National Institute of Cardiology, Warsaw, Poland.
Cardiovasc Drugs Ther. 2023 Feb;37(1):159-168. doi: 10.1007/s10557-021-07278-9. Epub 2021 Oct 20.
To compare effectiveness of different treatments for atrial fibrillation (AF) patients who were scheduled for cardioversion (CV) or ablation (CA) presenting with left atrium appendage (LAA) thrombus despite chronic oral anticoagulation therapy (OAC).
This was a retrospective cohort study. We analyzed 2014-2019 medical records of patients scheduled for CV or CA of AF who were diagnosed with LAA thrombus despite optimal OAC and had a follow-up transesophageal echocardiogram (TOE). Changes in treatment were divided into the following groups: switch to a drug with different mechanism of action, switch to a drug with similar mechanism of action, initiation of combination therapy, or deliberate no change in treatment. Patients with contraindications to non-vitamin K antagonists were excluded from the analysis.
We analyzed data of 129 patients comprising 181 cycles of treatment. The overall effectiveness of LAA thrombus dissolution was 51.9% regardless of the number of cycles and 42.6% for the first cycle of treatment. Any change of treatment was more effective than deliberate no change-OR 2.97 [95% CI: 1.07-8.25], P = 0.031, but no particular strategy seemed to be more effective than the other. Left atrium area (OR 0.908 [95% CI: 0.842-0.979]) and number of treatment cycles (OR 0.457 [95% CI: 0.239-0.872]) were both adversely related to thrombus resolution. There was one ischemic and three bleeding adverse events during the treatment.
LAA thrombus resolution in patients already on OAC may require a change of previous OAC treatment but the overall effectiveness of dissolution seems to be about 50%.
比较尽管接受慢性口服抗凝治疗（OAC），但仍计划行电复律（CV）或消融（CA）的心房颤动（AF）患者中，左心耳（LAA）血栓患者不同治疗的效果，这些患者尽管接受了 OAC，但仍存在 LAA 血栓。
这是一项回顾性队列研究。我们分析了 2014 年至 2019 年期间，计划行 AF 的 CV 或 CA，尽管 OAC 优化，但仍存在 LAA 血栓且具有随访经食管超声心动图（TOE）的患者的医疗记录。治疗变化分为以下组：转换为作用机制不同的药物，转换为作用机制相似的药物，启动联合治疗或故意不改变治疗。不包括 OAC 有禁忌证的患者。
我们分析了 129 例患者（共 181 个治疗周期）的数据。无论治疗周期的数量如何，LAA 血栓溶解的总体有效率为 51.9%，且第一个治疗周期的有效率为 42.6%。任何治疗变化均比故意不改变更有效-比值比（OR）为 2.97 [95%置信区间（CI）：1.07-8.25]，P=0.031，但似乎没有特定的策略比其他策略更有效。左心房面积（OR 0.908 [95% CI：0.842-0.979]）和治疗周期数量（OR 0.457 [95% CI：0.239-0.872]）均与血栓溶解呈负相关。在治疗过程中发生了 1 例缺血性和 3 例出血性不良事件。
LAA 血栓在已接受 OAC 的患者中可能需要改变先前的 OAC 治疗，但总体溶解有效率似乎约为 50%。
