Incidence and Predictors of Left Atrial Appendage Thrombus in Patients Treated With Nonvitamin K Oral Anticoagulants Versus Warfarin Before Catheter Ablation for Atrial Fibrillation

• Published in: The American journal of cardiology Vol. 119; no. 7; pp. 1017 - 1022
• Main Authors: Wyrembak, Joanne, MD, Campbell, Kristen B., PharmD, Steinberg, Benjamin A., MD, MHS, Bahnson, Tristram D., MD, Daubert, James P., MD, Velazquez, Eric J., MD, Samad, Zainab, MD, Atwater, Brett D., MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2017; Elsevier Limited
• Subjects: Age; Aged; Anticoagulants; Anticoagulants - therapeutic use; Atrial Appendage - diagnostic imaging; Atrial Appendage - surgery; Blood clots; Cardiac arrhythmia; Cardiovascular; Cardiovascular disease; Catheter Ablation; Catheters; Contrast Media; Diabetes; Echocardiography, Transesophageal; Factor Xa Inhibitors - therapeutic use; Female; Heart failure; Humans; Hypertension; Incidence; Intubation; Laboratories; Male; Middle Aged; Patients; Retrospective Studies; Risk Assessment; Stroke; Thromboembolism; Thrombosis - diagnostic imaging; Thrombosis - epidemiology; Thrombosis - prevention & control; Warfarin - therapeutic use
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2016.12.008

The utility of routine transesophageal echocardiography (TEE) to exclude left atrial appendage (LAA) thrombus before atrial fibrillation (AF) ablation in patients treated with nonvitamin K oral anticoagulant (NOAC) therapy is unclear. This single-center retrospective study sought to investigate the incidence of LAA thrombus in patients undergoing routine TEE before AF ablation treated with warfarin or NOAC therapy. We included 937 routine pre-AF ablation TEE procedures performed in patients treated with warfarin (n = 517) or NOAC (n = 420). Patients were anticoagulated without interruption for at least 4 consecutive weeks before the TEE. Patients treated with warfarin had lower LAA velocity and underwent TEE earlier in the study period than those treated with NOAC (p <0.05). The incidence of LAA thrombus was higher in patients treated with warfarin (1.55%, 8 of 517) compared with patients treated with NOAC (0.24%, 1 of 420, p = 0.0473 for difference). No LAA thrombus was identified in NOAC-treated patients with a CHA2 DS2 -VASC score <5 and in warfarin-treated patients with a CHA2 DS2 -VASC score <2. TEE-related complications occurred in 3 of 937 procedures (0.3%). In conclusion, LAA thrombus is detected rarely during pre-AF ablation TEE. Treatment with an NOAC is associated with a lower incidence of pre-AF ablation LAA thrombus compared with warfarin.