Second Division of Cardiology, Cardiac-Thoracic and Vascular Department, Azienda Ospedaliero Universitaria Pisana, University of Pisa, New Santa Chiara Hospital, Via Paradisa 2, 56124, Pisa, Italy.
J Interv Card Electrophysiol. 2022 Sep;64(3):773-781. doi: 10.1007/s10840-022-01169-1. Epub 2022 Mar 11.
The study aimed to explore the resolution of left atrial and left atrial appendage (LAA) spontaneous echo-contrast or thrombus in patients with nonvalvular atrial fibrillation/flutter (AF/AFL) under chronic oral anticoagulation (OAC).
A single-center retrospective analysis of patients who underwent a transesophageal echocardiography (TOE) for an electrical cardioversion was conducted.
Among 277 TOE performed, 73 cases (26%) of LAA echo-contrast or thrombus were detected, 53 patients with LAA/LA echo-contrast (19%) and 20 (7%) with a thrombus. All patients were under chronic anticoagulation with a VKA (65%) or with a NOAC (35%). The Echo-contrast Group maintained the same OAC strategy in 49 patients (93%). The Thrombus Group kept the same OAC strategy with a NOAC in 6 cases (30%) and changed the strategy in 14 patients (70%), titrating NOAC dose in 1 (5%) and the VKA dose in 4 (20%) and switching from NOAC to VKA in 5 (25%), from VKA to NOAC in 3 (15%), and from NOAC to NOAC in 1 (5%). Smoke resolution was observed in 4/40 cases (10%) of the smoke group and thrombus resolution in 8/15 (53%) of the thrombus group. Patients with thrombus resolution had a lower CHA2DS2-Vasc score (3.5 ± 2 vs 4 ± 1, p = 0.05), were more often under NOAC (37.5 vs 28%, p = 0.07), and had a longer anticoagulation time (7.5 vs 4 months, p = 0.08).
CONCLUSION (S): Changing OAC strategy is associated with thrombus resolution in more than 50% of chronically anticoagulated patients.
本研究旨在探讨非瓣膜性心房颤动/房扑（AF/AFL）患者在慢性口服抗凝治疗（OAC）下左心房和左心耳（LAA）自发性回声对比或血栓的消退情况。
对接受食管超声心动图（TOE）电复律的患者进行了一项单中心回顾性分析。
在进行的 277 次 TOE 中，73 例（26%）检测到 LAA 回声对比或血栓，53 例患者 LAA/LA 回声对比（19%）和 20 例（7%）有血栓。所有患者均接受 VKA（65%）或 NOAC（35%）的慢性抗凝治疗。回声对比组的 49 例患者（93%）维持相同的 OAC 策略。血栓组有 6 例（30%）保持相同的 NOAC 策略，14 例（70%）改变策略，其中 1 例（5%）调整 NOAC 剂量，4 例（20%）调整 VKA 剂量，5 例（25%）从 NOAC 转为 VKA，3 例（15%）从 VKA 转为 NOAC，1 例（5%）从 NOAC 转为 NOAC。在烟雾组的 40 例（10%）中观察到烟雾消退，在血栓组的 15 例（53%）中观察到血栓消退。血栓消退患者的 CHA2DS2-Vasc 评分较低（3.5±2 与 4±1，p=0.05），更常使用 NOAC（37.5%与 28%，p=0.07），抗凝时间更长（7.5 与 4 个月，p=0.08）。
改变 OAC 策略与超过 50%的慢性抗凝患者的血栓消退有关。
