Katic Josip, Borovac Josip Andelo
Cardiovascular Diseases Department, University Hospital of Split Split, Croatia.
Department of Pathophysiology, University of Split School of Medicine Split, Croatia.
Card Fail Rev. 2023 Apr 15;9:e05. doi: 10.15420/cfr.2022.28. eCollection 2023.
In patients with AF, the presence of left atrial/left atrial appendage (LA/LAA) thrombus is related to an increased risk of thromboembolic events. Anticoagulation therapy, either with vitamin K antagonists or novel oral anticoagulants (NOACs) is therefore mandatory in AF with LA/LAA thrombus in order to lower the risk of stroke or other systemic embolic events. Despite the efficacy of these treatments, some patients will have persistent LAA thrombus remaining or may have contraindications to oral anticoagulation. Currently, little is known about the occurrence, risk factors and resolution rate of LA/LAA thrombus in patients who are already under optimal chronic oral anticoagulation, including vitamin K antagonists or NOACs. The common action in clinical practice in this scenario is switching from one to another anticoagulant drug exhibiting a different mechanism of action. Repeated cardiac imaging is then advised within several weeks to visually verify thrombus dissolution. Finally, there is a substantial scarcity of data on the role and optimal use of NOACs after LAA occlusion. The aim of this review is to critically evaluate data and provide up-to-date information on the best antithrombotic strategies in this challenging clinical scenario.
在房颤患者中，左心房/左心耳（LA/LAA）血栓的存在与血栓栓塞事件风险增加相关。因此，对于伴有LA/LAA血栓的房颤患者，使用维生素K拮抗剂或新型口服抗凝药（NOACs）进行抗凝治疗是必需的，以降低中风或其他全身性栓塞事件的风险。尽管这些治疗方法有效，但一些患者的LAA血栓仍会持续存在，或者可能存在口服抗凝治疗的禁忌证。目前，对于已经接受最佳慢性口服抗凝治疗（包括维生素K拮抗剂或NOACs）的患者，LA/LAA血栓的发生情况、危险因素和溶解率知之甚少。在这种情况下，临床实践中的常见做法是从一种作用机制不同的抗凝药物转换为另一种。然后建议在几周内重复进行心脏成像，以直观地确认血栓溶解情况。最后，关于LAA闭塞后NOACs的作用和最佳使用的数据非常匮乏。本综述的目的是批判性地评估数据，并提供有关这一具有挑战性的临床情况下最佳抗栓策略的最新信息。
